摘要
目的观察罗哌卡因腹横肌平面阻滞(TAPB)用于剖宫产手术术后的镇痛效果、对产妇泌乳功能及新生儿的影响。方法选取2015年10月至2016年8月我院产科收治的行剖宫产手术产妇60例为研究对象,将入选产妇随机分为观察组与对照组,每组各30例。观察组在手术结束后予双侧TAPB(0.2%罗哌卡因,1.5 mg/kg)联合患者静脉自控镇痛(PCIA),对照组采用单纯PCIA。观察并记录两组患者术后4、8、12及48 h静息状态下的视觉模拟评分(VAS)及镇痛泵有效按压次数,产妇初乳时间,术前30 min、术后24及48 h血催乳素(PRL)水平,术后不良反应的发生情况,以及术后12、24及48 h的新生儿神经行为评分。结果观察组产妇术后4、8及12 h静息状态下VAS均显著低于对照组(P<0.05);两组产妇术后48 h静息状态下VAS比较差异无统计学意义(P>0.05);观察组产妇术后8、12及48 h镇痛泵有效按压次数均显著低于对照组(P<0.05);术后观察组产妇初乳时间为(21.94±2.15)h,显著低于对照组的(29.79±4.98)h(P<0.05);观察组产妇术后24及48 h血PRL水平均显著高于对照组(P<0.05);两组产妇术后头晕、皮肤瘙痒的发生率比较差异无统计学意义(P>0.05),观察组产妇术后恶心呕吐的发生率为13.3%,显著低于对照组的26.7%(P<0.05);术后12、24及48 h的新生儿神经行为评分,两组比较差异均无统计学意义(P>0.05)。结论剖宫产手术术后采用罗哌卡因TAPB进行镇痛能有效减少产妇术后疼痛,促进产妇早泌乳,不良反应较少且对新生儿神经行为无不良影响,值得临床推广应用。
Objective To observe the effects of ropivacaineon transversus abdominis plane block(TAPB) on postoperative analgesia,and the influence on prolactin level and neonates after caesarean section.Methods A total of 60 puerperae with caesarean section were collected from October 2015 to August 2016 in our hospital.They were randomly divided into two groups as 30 cases each group.The observation group was received TAPB combined with patient controlled intravenous analgesia(PCIA),the control group was received PCIA.The visual analogue scale(VAS) at rest and effective pressing times of postoperative analgesia pump in the two groups at 4,8,12 and 48 h after surgery were observed.The time for colostrums and the serum level of prolactin at 30 min before surgery and 24 and 48 h after surgery,the adverse reactions occurred after the surgery and the neonatal behavioral neurological assessment(NBNA) scores in the two groups at 12,24 and 48 h after surgery were compared.Results Compared with the control group,the rest VAS scores in observation group at 4,8 and 12 h after surgery were significantly lower(P<0.05).Effective pressing times of postoperative analgesia pump in observation group at 8,12 and 48 h after surgery were significantly lower than those in control group(P<0.05).The time for colostrums in observation group[(21.94±2.15)h] was significantly shorter than that in control group [(29.79±4.98) h](P<0.05).The serum level of prolactin at 24 and 48 h after surgery were significantly higher than those in control group(P<0.05).There was no significant difference in NBNA scores between the two groups at 12,24 and 48 h after surgery.Conclusion Ropivacaine TAPB combined with PCIA after caesarean section can relieve postoperative pain and improve the prolactin level without obvious adverse reactions on neonates.
出处
《世界临床药物》
CAS
2017年第9期623-628,共6页
World Clinical Drug
基金
河南省教育厅科学技术研究重点项目(编号:14A350032)
关键词
罗哌卡因
剖宫产术
产后镇痛
腹横肌平面阻滞
催乳素
新生儿神经行为评分
ropivacaine
caesarean section
postpartum analgesia
transversus abdominis plane block
prolactin
neonatal behavioral neurological assessment
