超声引导下不同入路腹横肌平面阻滞对剖宫产手术后镇痛的影响

发布时间：2018-02-04 03:47

本文关键词： 超声引导腹横肌平面阻滞不同入路剖宫产镇痛　出处：《首都医科大学学报》2015年05期 　论文类型：期刊论文

【摘要】：目的比较超声引导下腋前线入路和肋下入路腹横肌平面阻滞在纵切口剖宫产手术后镇痛的效果。方法实施单次蛛网膜下腔麻醉下纵切口剖宫产单胎足月孕初产妇144例,采用数字表法随机分为A组(腋前线入路组)和B组(肋下入路组)(n=72)。两组均在手术结束后在超声引导下行腹横肌平面阻滞,超声确定到达腹横肌平面后,双侧各注入0.25%罗哌卡因30m L。观察术后6、12、24、48 h时点视觉模拟评分(visual analogue score,VAS)情况、两组镇痛强度达峰时间、术后下床活动时间和患者对术后镇痛方式的满意度。结果术后6、12 h、24、48 h时点,两组的疼痛VAS差异均无统计学意义(P0.05)。A组镇痛强度达峰时间为(2.9±1.8)h;B组镇痛强度达峰时间为(2.6±1.4)h。两组的镇痛强度达峰时间和平均下床活动时间差异均无统计学意义(P0.05),两组产妇镇痛满意度差异均无统计学意义(P0.05)。结论超声引导下腋前线入路或肋下入路腹横肌平面阻滞均可提供24 h内纵切口下剖宫产手术镇痛,两种方法的术后镇痛效果无区别。
[Abstract]:Objective to compare the analgesic effect of anterior axillary approach and subcostal approach on abdominal transverse muscle block after cesarean section under single subarachnoid anesthesia. 144 cases. The patients were randomly divided into group A (axillary front approach) and group B (subcostal approach group) by digital table. 0.25% ropivacaine (30 mL) was injected into each side after ultrasound was confirmed to reach the level of the transverse abdominal muscle. Visual analogue score at 48 h and peak time of analgesic intensity in both groups were observed. The time of getting out of bed and the satisfaction of the patients with postoperative analgesia were analyzed. Results there were 24 hours and 48 hours after operation. There was no significant difference in pain VAS between the two groups. The peak time of analgesic intensity in group A was 2.9 卤1.8h. The peak time of analgesic intensity in group B was 2.6 卤1.4 h.There was no significant difference in peak time of analgesic intensity and average time of getting out of bed between the two groups (P 0.05). There was no significant difference in analgesic satisfaction between the two groups (P0.05). Conclusion Ultrasound-guided anterior axillary approach or subcostal approach of abdominal transverse muscle block can provide 24 h sublongitudinal incision cesarean section analgesia. There was no difference in postoperative analgesia between the two methods.
【作者单位】：海南医学院附属医院麻醉科;海南省人民医院麻醉科;
【分类号】：R614
【正文快照】： 超声引导下腹横肌平面(transversus abdominisplane,TAP)阻滞用于剖宫产手术的术后镇痛是近年来逐渐被认可的一项的镇痛技术。目前临床上常用的TAP技术主要有腋前线入路法和肋缘下入路法。虽然有报道[1]其对剖宫产术后镇痛的效果确切,然而有关进针入路的影响却鲜有报道。本研

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