摘要
目的探讨超声引导下双侧腹横肌平面阻滞(TAPB)在全身麻醉剖宫产中的临床应用效果。方法选取2018年5月~2019年10月于深圳市南山区妇幼保健院行全身麻醉剖宫产的60例产妇作为研究对象,利用随机数字表法将其分为观察组和对照组,每组各30例。对照组常规行全身麻醉剖宫产,观察组在对照组基础上术前行超声引导TAPB。比较两组产妇麻醉诱导至胎儿娩出时间、手术时间、术中出血量、瑞芬太尼用量、血压、心率,记录术后初乳时间以及疼痛视觉模拟量表(VAS)评分。比较两组新生儿出生后的Apgar评分、神经和适应能力评分(NACS)。结果观察组的瑞芬太尼用量少于对照组,差异有统计学意义(P<0.05)。胎儿娩出后,观察组的收缩压和心率均高于对照组,差异有统计学意义(P<0.05)。观察组术后2、4、12、24 h的术后VAS评分低于对照组,差异有统计学意义(P<0.05)。观察组的初乳时间早于对照组,差异有统计学意义(P<0.05)。两组术后4、12、24 h的VAS评分均低于术后2 h,差异有统计学意义(P<0.05)。观察组新生儿出生后1 min的Apgar评分高于对照组,差异有统计学意义(P<0.05)。两组新生儿出生后5 min的Apgar评分比较,差异无统计学意义(P>0.05)。两组新生儿出生后24、48 h的NACS评分比较,差异无统计学意义(P>0.05)。两组新生儿出生后48 h的NACS评分与本组出生后24 h比较,差异无统计学意义(P>0.05)。结论超声引导下TAPB应用于全身麻醉剖宫产中,能够减少全身麻醉药物对产妇的影响,减轻术后疼痛,减少胎儿抑制,值得临床推荐。
Objective To investigate the clinical application effect of ultrasound-guided transversus abdominis plane block(TAPB)in cesarean section under general anesthesia.Methods From May 2018 to October 2019,60 pregnant women underwent cesarean section under general anesthesia in Nanshan District Maternal and Child Health Hospital of Shenzhen City were selected as the research subjects.They were divided into observation group and control group by random number table method,30 cases in each group.The control group received general anesthesia cesarean section,and the observation group received ultrasound guided TAPB before operation on the basis of the control group.The time from anesthesia induction to fetal delivery,operation time,intraoperative blood loss,dosage of Remifentanil,blood pressure and heart rate were compared between the two groups.Postoperative colostrum time and visual analogue scale(VAS)score were recorded.The Apgar score,neurological and adaptive capacity score(NACS)after birth were compared between the two groups.Results The dosage of Remifentanil in the observation group was less than that in the control group,and the difference was statistically significant(P<0.05).After delivery of the fetus,systolic blood pressure and heart rate in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).The VAS scores at 2,4,12 and 24 h after surgery in the observation group were lower than those in the control group,with statistically significant differences(P<0.05).The colostrum time in the observation group was earlier than that in the control group,and the difference was statistically significant(P<0.05).The VAS scores at 4,12 and 24 h after surgery in both groups were lower than those at 2 h after surgery,with statistically significant differences(P<0.05).The Apgar score 1 min after birth in the observation group was higher than that in the control group,with statistically significant difference(P<0.05).There was no statistically significant difference between the two groups in Apgar score at 5 min after birth(P>0.05).There were no significant difference in NACS scores at 24 and 48 h after birth between the two groups(P>0.05).NACS scores of the two groups at 48 h after birth were compared with those of those at 24 h after birth,and the differences were not statistically significant(P>0.05).Conclusion Ultrason-guided TAPB application in general anesthesia cesarean section can reduce the influence of general anesthesia drugs on parturient women,reduce postoperative pain and fetal inhibition,worthy of clinical recommendation.
作者
刘海根
朱云娟
LIU Hai-gen;ZHU Yun-juan(Department of Anesthesiology,Nanshan District Maternal and Child Health Hospital,Guangdong Province,Shenzhen518000,China;Department of Gynecology,Shenzhen Hospital,Peking University,Guangdong Province,Shenzhen518035,China)
出处
《中国当代医药》
2020年第20期160-163,共4页
China Modern Medicine
关键词
剖宫产
双侧腹横肌平面阻滞
超声
全身麻醉
Cesarean section
Transversus abdominis plane block
Ultrasound
General anesthesia
