摘要
目的探讨地塞米松对罗哌卡因腹横肌平面(TAP)阻滞联合纳布啡静脉自控镇痛(PCIA)用于剖宫产术后镇痛的影响。方法纳入20~36岁,无主要系统性疾病,ASAⅠ~Ⅱ级,选择腰硬联合麻醉下行剖宫产手术的患者150例,随机分为TAP阻滞组和TAP阻滞+地塞米松组。TAP阻滞组(73例):手术结束经超声引导下行双侧TAP阻滞(0.33%罗哌卡因,共30 mL),纳布啡2 mg/kg+托烷司琼4 mg,共100 mL进行PCIA;TAP阻滞+地塞米松组(77例):手术结束经超声引导下行双侧TAP阻滞(0.33%罗哌卡因+地塞米松5 mg,共30 mL),余同TAP阻滞组。记录每组患者的年龄、ASA分级、体重指数(BMI)、入手术室的平均动脉压(MAP)和心率(HR);于术前、术后4 h和24 h采集患者外周静脉血,离心提取血浆,ELISA法测定血浆中TNF-α、IL-6含量;记录患者术后4、24 h VAS疼痛评分、Ramsay镇静评分、MAP和HR;记录患者术后即刻至首次肛门排气活动时间、首次下床活动时间、术后疼痛、恶心呕吐的发生例数以及处理情况等。结果TAP阻滞+地塞米松组术后4、24 h VAS疼痛评分、Ramsay镇静评分、MAP、HR、TNF-α、IL-6水平均低于TAP阻滞组(P<0.05);TAP+地塞米松组术后疼痛发生例数、镇痛药物使用剂量均少于TAP阻滞组(P<0.05);TAP+地塞米松组术后即刻至首次肛门排气时间、首次下床活动时间均短于TAP阻滞组(P<0.05)。结论地塞米松加入罗哌卡因中TAP阻滞联合纳布啡PCIA,改善了剖宫产术后镇痛的效果,有利于产妇术后恢复,提高了产妇术后的舒适度,是一种可供选择的剖宫产术后镇痛方法。
Objective To investigate the analgesic effect of ropivacaine and dexamethasone(DE)on abdominal transverse muscle plane(TAP)block combined with nalbuphine patient controlled intravenous analgesia(PCIA)after cesarean section.Methods 150 patients of 18~65 years,ASA physical statusⅠ-Ⅱ,undergoing cesarean section under combined spinal and epidural anesthesia were divided into group TAP and group TAP+DE.The patients were given PCIA at the end of the surgery(nalbuphine for 2 mg/kg+tropisetron 4 mg,100 ml).The patients from group TAP were underwent ultrasound-guided bilateral tap block(0.33%ropivacaine,in total 30 ml).The patients from group TAP+DE were underwent ultrasound-guided bilateral tap block(0.33%ropivacaine+dexamethasone 5 mg,in total 30 ml).The height,weight,body mass index(BMI),vital signs of all patients were recorded,and the levels of TNF-αand IL-6 in plasm were measured.Vas pain scores,Ramsay sedation scores,vital signs and the content of TNF-αand IL-6 at 4 and 24 hours after surgery were recorded.The incidence of postoperative analgesia,postoperative nausea and vomiting and antiemetic dosage,the time of end the operation to the first anus exhaust and get out of bed were recorded.Results The vas pain score,Ramsay sedation score,MAP,HR,TNF-αand IL-6 in group TAP+DE were significantly lower than those in group TAP both post-operation 4 h and 24 h(P<0.05);The incidence of pain,the dosage of analgesic drugs and antiemetic drugs in group TAP+DE were significantly lower than those in group TAP(P<0.05);The time of end the operation to the first anus exhaust and get out of bed in group TAP+DE were significantly shorter than those in group TAP(P<0.05).Conclusion Ropivacaine and dexamethasone tap block combined with nalbuphine PCIA is an alternative method for postoperative analgesia after cesarean section,which can improve the comfort and postoperative recovery of patients.
作者
兰云丽
魏义勇
王海英
Lan Yunli;Wei Yiyong;Wang Haiying(Department of Anesthesiology,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou 563099,China)
出处
《合肥医科大学学报》
2020年第3期338-342,共5页
Journal of Zunyi Medical University
基金
贵州省科技计划项目(NO:黔科合基础[2018]1195)。
关键词
地塞米松
纳布啡
TAP阻滞法
剖宫产
PCIA
dexamethasone
nalbuphlne
transverse muscle plane block
cesarean section
PCIA
