超声引导下腹横肌平面阻滞在剖宫产腰硬联合麻醉中的应用价值(1)
[摘要]目的 探討超声引导下腹横肌平面(TAP)阻滞在剖宫产腰硬联合麻醉中的应用价值。方法 选取2017年3月～2018年3月我院妇产科收治的60例在腰硬联合麻醉下行剖宫产的产妇作为研究对象，按照随机数字表法将其分为实验组和对照组，每组各30例。对照组产妇给予腰硬联合麻醉+传统TAP阻滞麻醉，实验组产妇给予腰硬联合麻醉+超声引导下TAP阻滞。比较两组产妇切皮前、胎儿娩出时及手术结束时的心率、平均动脉压、疼痛评分[视觉模拟量表(VAS)评分];比较两组产妇术后2、4、8、16、24、36 h的疼痛评分;比较两组产妇术中牵拉反应、不良反应(恶心呕吐)的发生情况;比较两组产妇镇痛泵按压次数及第1次下地所需时间。结果 实验组产妇切皮前、胎儿娩出时及手术结束时的心率、平均动脉压及VAS评分均低于对照组，差异有统计学意义(P<0.05)。两组产妇术后2 h的VAS评分比较，差异无统计学意义(P>0.05);实验组产妇产后4、8、16、24、36 h的VAS评分低于对照组，差异有统计学意义(P<0.05)。实验组产妇的术中牵拉反应发生率、不良反应发生率低于对照组，镇痛泵按压次数少于对照组，第1次下地所需时间短于对照组，差异均有统计学意义(P<0.05)。结论 超声引导下TAP阻滞应用于剖宫产腰硬联合麻醉中的效果良好，能够有效降低产妇的不良反应发生率，缓解术后疼痛，值得推广及应用。
[关键词]超声引导;腹横肌平面;剖宫产;腰硬联合麻醉
[中图分类号] R614.4 [文献标识码] A [文章编号] 1674-4721(2019)9(c)-0117-04
[Abstract] Objective To explore the application value of ultrasound-guided transversal abdominis plane (TAP) block in combined spinal-epidural anesthesia of cesarean section. Methods Sixty puerpera who underwent cesarean section with combined spinal and epidural anesthesia from March 2017 to March 2018 admitted to our hospital were divided into experimental group and control group according to the random number table method， with 30 cases in each group. The control group was given combined spinal-epidural anesthesia + traditional TAP block anesthesia， while the experimental group was given combined spinal-epidural anesthesia + ultrasound-guided TAP block. The heart rate， mean arterial pressure and pain score (visual analogue scale [VAS] score) before the incision， at the time of delivery and at the end of the operation of the two groups were compared. The pain scores at 2， 4， 8， 16， 24， and 36 h after surgery of the two groups were compared. The occurrence of intraoperative traction reaction， adverse reactions (nausea and vomiting) of the two groups were compared. The number of times that the analgesic pump was pressed， and the time required for the first time to go to the ground of the two groups were compared. Results The heart rate， mean arterial pressure and VAS scores of the experimental group were lower than those of the control group before skin incision， at the time of fetal delivery and at the end of the operation， and the differences were statistically significant (P<0.05). There was no significant difference in VAS score between the two groups 2 h after operation (P>0.05). The VAS scores of the experimental group at 4， 8， 16， 24， 36 h after delivery were lower than those of the control group， the differences were statistically significant (P<0.05). The incidence of traction reaction and adverse reactions during operation in the experimental group were lower than those in the control group， the number of times that the analgesic pump was pressed was fewer than that in the control group， and the time required for the first time to go to the ground was shorter than that in the control group， the differences were statistically significant (P<0.05). Conclusion Ultrasound-guided TAP block is more effective in cesarean section combined with spinal and epidural anesthesia. It can effectively reduce the incidence of adverse reactions and relieve postoperative pain， thus it is worthy of promotion and application., 百拇医药(文日新 王兴高 廖容珍 卓锐 陈广田)
[关键词]超声引导;腹横肌平面;剖宫产;腰硬联合麻醉
[中图分类号] R614.4 [文献标识码] A [文章编号] 1674-4721(2019)9(c)-0117-04
[Abstract] Objective To explore the application value of ultrasound-guided transversal abdominis plane (TAP) block in combined spinal-epidural anesthesia of cesarean section. Methods Sixty puerpera who underwent cesarean section with combined spinal and epidural anesthesia from March 2017 to March 2018 admitted to our hospital were divided into experimental group and control group according to the random number table method， with 30 cases in each group. The control group was given combined spinal-epidural anesthesia + traditional TAP block anesthesia， while the experimental group was given combined spinal-epidural anesthesia + ultrasound-guided TAP block. The heart rate， mean arterial pressure and pain score (visual analogue scale [VAS] score) before the incision， at the time of delivery and at the end of the operation of the two groups were compared. The pain scores at 2， 4， 8， 16， 24， and 36 h after surgery of the two groups were compared. The occurrence of intraoperative traction reaction， adverse reactions (nausea and vomiting) of the two groups were compared. The number of times that the analgesic pump was pressed， and the time required for the first time to go to the ground of the two groups were compared. Results The heart rate， mean arterial pressure and VAS scores of the experimental group were lower than those of the control group before skin incision， at the time of fetal delivery and at the end of the operation， and the differences were statistically significant (P<0.05). There was no significant difference in VAS score between the two groups 2 h after operation (P>0.05). The VAS scores of the experimental group at 4， 8， 16， 24， 36 h after delivery were lower than those of the control group， the differences were statistically significant (P<0.05). The incidence of traction reaction and adverse reactions during operation in the experimental group were lower than those in the control group， the number of times that the analgesic pump was pressed was fewer than that in the control group， and the time required for the first time to go to the ground was shorter than that in the control group， the differences were statistically significant (P<0.05). Conclusion Ultrasound-guided TAP block is more effective in cesarean section combined with spinal and epidural anesthesia. It can effectively reduce the incidence of adverse reactions and relieve postoperative pain， thus it is worthy of promotion and application., 百拇医药(文日新 王兴高 廖容珍 卓锐 陈广田)