摘要
目的比较超声引导下腰方肌阻滞（quadratus lumborum block，QLB）与腹横肌平面阻滞（transversus abdominis planeblock，TAPB）在下腹部正中切口剖宫产术后镇痛中的效果。方法选择80例行下腹部正中切口剖宫产产妇，ASA分级Ⅰ、Ⅱ级，采用随机数字表法分为QLB组（Q组）和TAPB组（T组），每组40例。产妇在蛛网膜下腔搬膜外联合麻醉下行下腹部正中切口剖宫产术，术后在超声引导下，Q组产妇于腰方肌后表面胸腰筋膜（thoracolumbar fascia,TLF）内，每侧注射0．375％罗哌卡因20ml，T组于腹内斜肌和腹横肌之间，每侧注射0．375％罗哌卡因20ml。记录两组产妇术后第4、8、12、24、48小时的静息VAS评分、运动VAS评分、舒芬太尼消耗量，记录两组产妇术后副作用的发生情况，记录产妇对术后镇痛的满意度。结果两组产妇术后不同时间点静息VAS评分差异无统计学意义（P〉0．05）；与T组比较，Q组在术后8、12、24、48h舒芬太尼消耗量及运动VAS评分均降低（P〈0．05）；Q组副作用发生率下降（P〈0．05）。结论采用0．375％罗哌卡因行双侧QLB用于剖宫产术后镇痛，可显著减少剖宫产产妇术后阿片类药物用量，降低术后运动VAS评分，提高产妇满意度。
Objective To compare the postoperative analgesic effect of ultrasound-guided quadratus lumborum block（QLB） and transversus abdominis plane block （TAPB） block in caesarean delivery with median incision in the lower abdomen. Methods Eighty patients undergoing caesarean delivery with the median incision of the lower abdomen, classified as ASA Ⅰ or Ⅱ , were randomly divided into QLB group （group Q, n=40） and TAPB group （group T, n=40）. Puerperants were scheduled for caesarean delivery under combined spinal and epidural anesthesia with median incision in the lower abdomen. After surgery, patients in group Q received ultrasound-guided QLB with bilateral ropivacaine （20 ml of 0.375%） injection into thoracolumbar fascia behind quadratus lumborum. Patients in group T received ultrasound -guided TAPB with ropivaeaine （20 ml of 0.375%） bilaterally. The resting and exercise VAS scores and the consumption of sufentanil 4, 8, 12, 24, 48 h after operation were recorded. The incidences of postoperative adverse reactions and patients＇ satisfaction with postoperative analgesia were also documented. Results There was no significant difference in postoperative resting VAS scores between the two groups（P〉0.05）. The exercise VAS scores 8, 12, 24, 48 h after operation and the consumption of sufentanil in group Q were significantly lower than those in group T（P〈0.05）. Patients in group Q had lower incidence of adverse reactions （P〈0.05）. Conclusions Ultrasound-guided bilateral QLB with ropivacaine can reduce the consumption of opioid drugs after caesarean delivery, reduce the exercise VAS score, and improve patients＇ satisfaction.
作者
李刚
茹克娅木·买买提
盖殿秀
Li Gang;Rukeyee Mamat;Gai Dianxiu(Department of A nesthesiology, the 148th Hospital of PLA, Zibo 255300, China;Department of Anesthesiology, People＇s Hospital of Shache County, the Xinjiang Uygur Autonomous Region Kashi Area, Shache 844700, Chin)
出处
《国际麻醉学与复苏杂志》
CAS
2018年第4期338-340,345,共4页
International Journal of Anesthesiology and Resuscitation
关键词
腰方肌阻滞
剖宫产
术后镇痛
Quadratus lumborum block
Caesarean section
Postoperative analgesia
