腹横肌平面阻滞在产科加速康复中的应用价值

Role of transverse abdominis plane block in enhanced recovery after cesarean section

目的:观察腹横肌平面阻滞(TAP)对剖宫产产妇术后镇痛的影响,评价其在产科加速康复中的作用。方法:将200例剖宫产产妇随机分成4组,分别为硬膜外镇痛(PCEA)组、静脉镇痛(PCIA)组、TAP+硬膜外镇痛(TAP1)组和TAP+静脉镇痛(TAP2)组,观察每组的镇痛VAS评分、镇痛泵的用药量及按压次数、不同时刻血清乳泌素水平、术后第一次泌乳时间、开始进食时间和肛门排气时间、住院天数和不良反应。结果:TAP1组和TAP2组术后24 h镇痛VAS评分明显低于PCEA组和PCIA组(P<0. 05);镇痛泵的用药量和按压次数明显少于PCEA组和PCIA组(P<0. 05),术后血清乳泌素水平明显高于PECA组和PCIA组(P<0. 05),术后第一次泌乳时间,开始进食时间和肛门排气时间明显提前(P<0. 05),住院天数减少(P<0. 05),不良反应明显减少(P<0. 05),TAP1组的尿潴留和腹胀不良反应多于TAP2组,但TAP1与TAP2组间结果比较均没有统计学差异。结论:腹横肌平面阻滞联合多模式镇痛能提高剖宫产术后的镇痛效果,是推动加速康复外科理念在剖宫产围术期应用的一种积极方法。

Objective: To observe the effect of transverse abdominis plane block(TAP) on postoperative analgesia of cesarean section and evaluate its role in enhanced recovery after surgery(ERAS).Methods:Two hundreds women with cesarean section were randomly divided into 4 groups: patient-controlled epidural analgesia(PCEA) group, patient-controlled intravenous analgesia(PCIA) group, TAP +PCEA(TAP1) group, and TAP+ PCIA(TAP2) group;the VAS score, the dose of analgesic and the times of compression of PCA pump, the level of serum lactotropin at different times, the first lactating after surgery, the time of starting to eat, the anal exhaust time, hospital length of stay and sideeffects were recorded.Results: The VAS scores of TAP1 group and TAP2 group were significantly lower than those of PCEA group and PCIA group(P<0. 05). The dose of analgesic and compression times of PCA pump produced remarkable drop as compared with PCEA group and PCIA group(P<0. 05). The level of serum lactotropin in TAP1 group and TAP2 group was higher than that in PCEA group and PCIA group(P<0. 05), meanwhile, the first lactating time, the beginning of feeding time and the anal exhaust time in TAP1 group and TAP2 group were significantly earlier than those in PCEA group and PCIA group(P<0. 05). In TAP1 group and TAP2 group, the hospital days decreased(P<0. 05), and the side effects were significantly reduced(P<0. 05). The extent of urinary retention and flatulence in TAP1 group was greater than that in TAP2 group, but there was no statistical difference.Conclusion: The TAP combined with multimodal analgesia can improve the analgesic effect after cesarean section, which is a positive way to promote the application of ERAS in perioperative period of cesarean section.