局部浸润镇痛和腹横肌平面阻滞用于剖宫产术后镇痛效果比较.docVIP

局部浸润镇痛和腹横肌平面阻滞用于剖宫产术后镇痛的效果比较 　　[摘要] 目的 比?^局部浸润镇痛（LIA）和腹横肌平面（TAP）阻滞用于剖宫产术后镇痛的效果。 方法 选取2016年8～12月武汉大学中南医院收治的60例择期行剖宫产术产妇作为研究对象，采用随机数字表法将患者分为两组：LIA组（I组）、TAP阻滞组（T组），每组各30例。所有产妇均在腰硬联合麻醉下行剖宫产术，I组在关腹之前由手术者给予0.25%罗哌卡因40 mL腹部切口逐层浸润镇痛，T组在术毕行超声引导下双侧TAP阻滞，每侧注射0.25%罗哌卡因20 mL。术毕两组患者均使用舒芬太尼静脉自控镇痛泵，记录术后4、8、12、24 h患者的视觉模拟疼痛（VAS）评分，镇痛泵按压次数、镇痛不良反应（恶心呕吐和尿潴留）的发生情况以及患者满意度评分。 结果 两组产妇不同时点的VAS评分比较差异无统计学意义（P 0.05）。与I组比较，T组镇痛泵按压次数较少、镇痛满意度评分较高（P 0.05）。T组患者术后不良反应的发生率低于I组（P 0.05）。 结论 相对于切口LIA，超声引导下TAP阻滞更有助于提高剖宫产术后镇痛的效果，减少静脉镇痛药用量，降低镇痛相关不良反应的发生，增加患者镇痛满意度。 　　[关键词] 浸润镇痛；腹横肌平面阻滞；剖宫产；术后镇痛 　　[中图分类号] R971.2 [文献标识码] A [文章编号] 1673-7210（2017）12（a）-0058-04 　　[Abstract] Objective To compare analgesia effects between local infiltration analgesia and bilateral ultrasound-guided TAP block after cesarean section. Methods A total of 60 parturients scheduled for elective cesarean section in Zhongnan Hospital of Wuhan University from August to December 2016 were selected as research subjects. They were randomly divided into two groups using a random number table： local infiltration analgesia group （group I） and transversus abdominis plane block group （group T）， with 30 cases in each group. All parturients underwent cesarean delivery under combined spinal and epidural anesthesia. In the group I， 0.25% Ropivacaine 20 mL was given to the abdominal incision layer in each side for infiltration analgesia before the abdomen was closed； in the group T， parturients received 0.25% Ropivacaine 20 mL bilaterally in the TAP block under the guidance of ultrasound. A Sulfentanil patient-controlled intravenous analgesia pump was used for all patients at the end of surgery. The VAS scores， the number of pressing times of the analgesic pump， the incidence of side effects （nausea and vomiting and urinary retention） and patients′ satisfaction were recorded. Results There was no significant difference in VAS scores between the two groups （P 0.05）. Compared with group I， the number of pressing times was less and patient satisfa