摘要
目的探讨右美托咪定复合罗哌卡因超声引导下双侧腹横肌平面阻滞(TAPB)对二次剖宫产产妇术后多模式镇痛的影响。方法择期椎管内麻醉行二次剖宫产术的产妇60例,采用随机数字表法分为对照组和观察组,每组30例。两组术毕均在超声引导下行双侧TAPB,对照组每侧给予0.5%罗哌卡因20 ml,观察组每侧给予0.5%罗哌卡因20 ml和0.75μg/kg右美托咪定。两组均行静脉自控镇痛(PCIA)。记录产妇术后4 h(T1)、8 h(T2)、12 h(T3)、24 h(T4)静息疼痛视觉模拟评分(VAS)、运动VAS、Ramsay镇静评分及舒适度评分(BCS);记录TAPB到首次按压镇痛泵的时间、产妇术后24 h舒芬太尼用量;计算术后24 h内PCIA有效按压次数与实际按压次数比(D1/D2);记录术后产妇满意度及术后不良反应如恶心呕吐、呼吸抑制、头晕头痛等发生情况。结果两组T1时静息VAS评分差异无统计学意义(t=1.01,P>0.05),T2、T3、T4时观察组静息VAS评分均明显低于对照组(t分别=2.74、2.05、1.97,P均<0.05),T1、T2、T3、T4时观察组运动VAS评分低于对照组,BCS评分高于对照组,差异均有统计学意义(t分别=2.33、2.68、2.55、2.37;2.13、2.68、2.74、2.47,P均<0.05),但两组T1、T2、T3、T4 Ramsay镇静评分比较,差异无统计学意义(t分别=0.65、0.84、0.69、0.93,P均>0.05)。与对照组比较,观察组产妇行TAPB后到首次按压镇痛泵的时间明显延长,术后24 h舒芬太尼用量明显降低,D1/D2明显增高(t分别=1.69、2.04、2.75,P均<0.05),观察组产妇术后满意度明显增高,术后恶心呕吐、头晕头痛等不良反应生率明显降低(χ2分别=4.32、4.04、5.19,P均<0.05)。结论右美托咪定复合罗哌卡因超声引导下双侧腹横肌平面阻滞能显著延长镇痛时间及增加二次剖宫产产妇术后多模式镇痛强度,且副作用较少。
Objective To observe the effect of dexmedetomidine combined with ropivacaine TAPB on multimodal analgesia after second cesarean section.Methods Totally 60 puerperants who subjected to secondary cesarean sections under spinal cord anesthesia were randomly divided into the observation group and control group,30 patients in each.The two groups were treated by ultrasound-guided bilateral TAPB,the control group was given 0.5%ropivacaine 20 ml,the observation group was given 0.5%ropivacaine 20ml and 0.75μg/kg dexmedetomidine.PCIA was performed in both groups.The rest VAS score,exercise VAS score,Ramsay sedation score and BCS comfort score were recorded at 4 h(T1),8 h(T2),12 h(T3)and 24 h(T4)after operation;the time from TAPB to the first compression of analgesia pump and sufentanil dosage at 24 hours postoperatively were recorded;the ratio of PCIA effective compression times to actual compression times(D1/D2)within 24 hours postoperatively was calculated;the satisfaction of postoperatively pregnant women and adverse reactions such as heart vomiting,respiratory depression,dizziness and headache were recorded.Results There was no significant difference between the two groups in resting VAS score at T1(t=1.01,P>0.05)and the resting VAS score of the observation group at T2,T3,T4 were lower than that of control group(t=2.74,2.05,1.97,P<0.05),the exercise VAS score of the observation group at T1,T2,T3,T4 were lower than that of control group(t=2.33,2.68,2.55,2.37,P<0.05)as well as the BCS comfort score(t=2.13,2.68,2.74,2.47,P<0.05),but there was no significant difference in Ramsay sedation score between the two groups at T1,T2,T3,T4(t=0.65,0.84,0.69,0.93,P>0.05).Compared with the control group,the time from TAPB to the first time of pressing the analgesia pump in the observation group was significantly longer,the dosage of sufentanil was significantly reduced,the D1/D2 was significantly higher(t=1.69,2.04,2.75,P<0.05),the satisfaction of the observation group was significantly higher,the incidence of adverse reactions such
作者
杜瑞
刘静
赵燕
黄新华
DU Rui;LIU Jing;ZHAO Yan(Department of Anesthesiology,Huzhou Maternity and Child Health Care Hospital,Huzhou 313000,China)
出处
《全科医学临床与教育》
2019年第12期1093-1096,共4页
Clinical Education of General Practice
关键词
右美托咪定
罗哌卡因
超声引导下双侧腹横肌平面阻滞
二次剖宫产
多模式镇痛
dexmedetomidine
ropivacaine
ultrasound-guided bilateral transversus abdominis plane block
secondary cesarean section
postoperative multimode analgesia
