摘要
目的观察超声引导下腹横肌平面(TAP)阻滞用于剖宫产术患者术后镇痛的效果。方法择期腰硬联合麻醉下行剖宫产术患者60例,ASA分级Ⅰ级或Ⅱ级,分为罗哌卡因组(Ⅰ组)和等量0.9%氯化钠溶液组(Ⅱ组)。手术完成后在超声引导下行双侧TAP阻滞,Ⅰ组每侧注射0.375%罗哌卡因20ml,Ⅱ组每侧注射等容量0.9%氯化钠溶液。术毕所有患者均行经静脉患者自控镇痛(PCIA)。比较两组术后2 h、6 h、12 h、24 h、48 h静态和动态视觉模拟疼痛(VAS)评分,记录两组术后镇痛泵第一次按压时间、24 h镇痛泵按压次数、镇痛满意度、PCIA的用量以及不良反应的发生情况。结果两组术后2 h、6 h、12 h、24 h、48 h的静态VAS评分比较,差异无统计学意义(t分别=1.85、1.96、1.99、1.96、1.63,P均>0.05)。Ⅰ组术后2 h、6 h、12 h和24 h时点的动态VAS评分明显低于Ⅱ组,差异有统计学意义(t分别=4.46、4.95、5.13、3.08,P均<0.05)。Ⅰ组术后镇痛泵第一次按压时间比Ⅱ组延迟(t=6.82,P<0.05),24 h镇痛泵按压次数比Ⅱ组少(t=6.17,P<0.05),镇痛满意度比Ⅱ组高(χ2=4.32,P<0.05),术后24 h内PCIA使用量比Ⅱ组更少(t=7.32,P<0.05)。两组均未见与TAP穿刺相关的并发症,两组术后恶心、呕吐等不良反应发生率的比较,差异无统计学意义(χ2分别=0.23、0.10,P均>0.05)。结论超声引导下TAP阻滞用于剖宫产术患者的术后镇痛效果好,减少了PCIA的需要量。
Objective To observe the efficacy of ultrasound-guided transversus abdominis plane（TAP） block for postoperative analgesia in patients with caesarean delivery. Medthods Sixty ASA Ⅰ- Ⅱ patients that scheduled for elective caesarean delivery under combined spinal-epidural anesthesia were randomly divided into two groups with 30 cases in each： ropivacaine group（groupⅠ） and same volume saline group（groupⅡ）. The ultrasound-guided bilateral TAP block was performed at the end of surgery, and 0.375% ropivacaine 20 ml was injected to each side in group Ⅰ while the equal volume of normal saline was injected in group Ⅱ. After that, all patients received patient controlled intravenous analgesia（PCIA）. The visual analogue scale（VAS） scores at 2-hour, 6-hour, 12-hour, 24-hour and 48-hour at rest and movement, the time to require the first bolus, and the numbers of bolus in 24 hours, the satisfaction on analgesia, total consumption of PCIA and the adverse reactions were all recorded and compared. Results The VAS scores at rest of two groups were not statistical different at 2-hour, 6-hour, 12-hour, 24-hour and 48-hour（t=1.85, 1.96, 1.99, 1.96, 1.63,P〈0.05）. The VAS scores at movement in group Ⅰ were significantly lower at 2-hour, 6-hour, 12-hour and 24-hour after operation than group Ⅱ（t=4.46, 4.95, 5.13, 3.08, P〈0.05）. In group Ⅰ, the time to require the first bolus was significantly longer than group Ⅱ（t=6.82,P〈0.05）, the compression numbers were significantly less（t=6.17,P〈0.05）, the satisfaction on analgesia were significantly better（χ^2=4.32,P〈0.05） and the consumption of PCIA were significantly lower（t =7.32, P 〈0.05）. TAP block-related complications were not found in two groups, and the incidence of postoperative nausea,vomiting had no statistic differences（χ^2=0.23, 0.10,P〉 0.05）. Conclusion Ultrasound-guided TAP block forpostoperative analgesia is effective in patients with elective caesarean delivery and the requirement ofPCIA analgesics is decreased.
出处
《全科医学临床与教育》
2015年第1期25-28,共4页
Clinical Education of General Practice
关键词
腹横肌平面阻滞
术后镇痛
剖宫产
transversus abdominis plane block
postoperative analgesia
caesarean delivery
