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罗哌卡因复合右美托咪定腹横肌平面阻滞镇痛对剖宫产术后子宫血流动力学、泌乳及胃肠功能的影响 被引量:16

Effect of ropivacaine combined with dexmedetomidine for transversus abdominis plane block analgesia on uterine hemodynamics,lactation,and gastrointestinal function after cesarean section
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摘要 目的:分析罗哌卡因复合右美托咪定腹横肌平面阻滞(transversus abdominis plane block,TAPB)镇痛对剖宫产术后子宫血流动力学、泌乳及胃肠功能的影响。方法:选取2021年6月至2022月1月在秦皇岛市妇幼保健院妇产科行剖宫产术的150例产妇作为研究对象,采用随机数据表法将其分为研究组与对照组,每组75例。研究组产妇术后采用罗哌卡因复合右美托咪定TAPB联合舒芬太尼自控静脉镇痛(patient-controlled intravenous analgesia,PCIA),对照组产妇采用单纯PCIA。对两组产妇的一般资料、镇痛效果进行比较;对两组产妇产前和术后72 h时的子宫动脉收缩期最大血流速度(peak systolic blood flow velocity,PSV)、舒张末期血流速度(end diastolic blood flow velocity,EDV)、阻力指数(resistance index,RI)、搏动指数(pulsatilit yindex,PI)进行比较;对两组产妇的初乳分泌时间、泌乳量及产前、术后24 h时的血清催乳素(prolactin,PRL)水平进行比较;对两组产妇术后72 h内镇痛不良反应的发生率进行比较。结果:在术后各个时点,研究组产妇的视觉模拟量表(Visual Analogue Scale,VAS)评分均低于对照组,Ramsay镇静评分均高于对照组。研究组产妇的镇痛泵首次按压时间长于对照组,镇痛泵按压次数、舒芬太尼用量均低于对照组。研究组产妇术后72 h时子宫动脉PSV、EDV、PI均高于对照组,RI低于对照组。研究组产妇的泌乳量和术后24h时血清PRL水平均高于对照组,初乳分泌时间、首次肛门排气时间、首次排便时间、肠鸣音恢复正常时间均短于对照组。研究组产妇术后恶心呕吐的发生率及镇痛不良反应总发生率均高于对照组。以上差异均有统计学意义(均P<0.05)。结论:在剖宫产术后应用罗哌卡因复合右美托咪定TA PB镇痛联合舒芬太尼PCI A,能够达到优于单独应用PCI A的镇痛效果,可减少阿片类药物用量和镇痛不良反应,且在促进泌乳和胃肠功能、子� Objective:To analyze the effect of ropivacaine combined with dexmedetomidine for transversus abdominis plane block(TAPB)analgesia on uterine hemodynamics,lactation,and gastrointestinal function after cesarean section.Methods:A total of 150 pregnant women who underwent cesarean section in Department of Obstetrics and Gynecology of Qinhuangdao Maternal and Child Health Hospital from June 2021 to January 2022 were selected as research subjects.They were randomly divided into a study group and a control group,with 75 cases in each group.The subjects in the study group were treated with ropivacaine combined with dexmedetomidine TAPB combined with sufentanil for patient-controlled intravenous analgesia(PCIA),and the subjects in the control group were treated with PCIA alone.The general data and analgesic effects between the 2 groups were compared.The peak systolic blood flow velocity(PSV),the end diastolic blood flow velocity(EDV),the resistance index(RI),and the pulsatility index(PI)of uterine artery at prenatal and 72 h after the operation between the 2 groups were compared.The colostrum secretion time,the lactation volume,and the serum prolactin(PRL)levels at prenatal and 24 h after the operation between the 2 groups were compared.The incidence of analgesic adverse reactions within 72 h after the operation between the 2 groups was compared.Results:At each time point after the operation,the Visual Analogue Scale(VAS)scores of pregnant women in the study group were lower than those in the control group,and the Ramsay sedation scores were higher than those in the control group.The first compression time of analgesic pump of the subjects in the study group was longer than that in the control group,and the pressing times of analgesic pump and the dosage of sufentanil were lower than those in the control group.The PSV,EDV,and PI of uterine artery of the subjects in the study group were higher than those in the control group 72 h after the operation,and the RI was lower than that in the control group.The lactation volume a
作者 安艳萍 刘彦涛 廉伟 刘恒 崔鑫 华娜娜 AN Yanping;LIU Yantao;LIAN Wei;LIU Heng;CUI Xin;HUA Nana(Department of Anesthesiology,Qinhuangdao Maternal and Child Health Hospital,Qinhuangdao Hebei 066000,China)
出处 《临床与病理杂志》 CAS 2022年第11期2738-2744,共7页 Journal of Clinical and Pathological Research
关键词 罗哌卡因 右美托咪定 腹横肌平面阻滞 术后镇痛 血流动力学 胃肠功能 ropivacaine dexmedetomidine transversus abdominis plane block postoperative analgesia hemodynamics gastrointestinal function
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