摘要
目的:比较超声引导下腹横肌平面阻滞(transversus abdominis plane block,TAPB)镇痛和腰方肌阻滞(quadratus lumborum block,QLB)镇痛用于HIV感染孕产妇剖宫产术后镇痛效果及对细胞免疫的影响。方法:选择在重庆市公共卫生医疗救治中心接受剖宫产手术的HIV感染孕产妇60例,年龄22~32岁,体质指数(body mass index,BMI)18~25 kg/m2,ASAⅡ级。随机分为TAPB组和QLB组,每组30例。2组均采用腰-硬联合麻醉,术后行静脉自控镇痛(patient controlled intravenous analgesia,PCIA),QLB组术毕行超声引导下腰方肌阻滞,TAPB组行超声引导下腹横肌阻滞。记录术后4、8、12、24、36 h的静态VAS疼痛评分;术前1 d、术后1、2、3 d取外周血,检测白细胞介素(interleukin,IL)-2、IL-13、γ干扰素(interferon-γ,IFN-γ)浓度和CD3^(+)、CD4^(+)、CD8^(+)含量及CD4^(+)/CD8^(+);记录镇痛泵首次按压时间、术后补救性镇痛例数、一次穿刺成功率及不良麻醉反应。结果:与TAPB组术后4、8、12、24、36 h比较,QLB组各时间点静态VAS疼痛评分均明显降低(P<0.05)。与TAPB组术后1、2、3 d比较,QLB组各时间点IL-2、IL-13、IFN-γ浓度和CD4+含量以及CD4^(+)/CD8^(+)均明显升高(P<0.05)。QLB组镇痛泵首次按压时间明显晚于TAPB组,补救性镇痛率明显低于TAPB组(P<0.05)。结论:HIV感染孕产妇剖宫产术后实施经腰方肌阻滞镇痛效果确切,能够减轻对细胞免疫的影响。
Objective:To study the analgesic effect of transversus abdominis plane block(TAPB)and quadratus lumborum block(QLB)on postpartum caesarean section of human immunodeficiency virus(HIV)-infected pregnant women and its influence on cellular immunity.Methods:Sixty HIV-infected pregnant women who underwent cesarean section in Chongqing Public Health Medical Center,aged 22-32,body mass index(BMI)18-25 kg/m2,ASAⅡ.They were randomly divided into TAPB group and QLB group,with 30cases in each group.Both groups were treated with combined spinal-epidural anesthesia,and underwent patient controlled intravenous analgesia(PCIA)after operation.The QLB group underwent ultrasound-guided bilateral QLB,and ultrasound-guided TAPB was conducted in TAPB group.The scores of resting VAS were recorded at 4 h,8 h,12 h,24 h,36 h after operation.The levels of interleukin(IL)-2,IL-13,interferon-γ(IFN-γ),CD3,CD4,CD8and CD4/CD8in peripheral blood were observed by 1 day before the operation and 1 day,2 days and 3 days after the operation.And the first compression time of the analgesic pump,the number of postoperative salvage analgesia cases,the success rate of one puncture and adverse anesthesia reactions.Results:Compared with the TAPB group at 4 h,8 h,12 h,24 h,and 36 h after surgery,the static VAS pain scores in the QLB group were significantly lower at each time point(P<0.05).Compared with the TAPB group 1 day,2 days and 3 days after the operation,the IL-2,IL-13,IFN-γconcentration,CD4and CD4/CD8in the QLB group were significantly increased at each time point(P<0.05).The first compression time of the analgesic pump in the QLB group was significantly later than that in the TAPB group(P<0.05),and the rate of remedial analgesia was significantly lower than that in the TAPB group(P<0.05).Conclusion:Post-operative cesarean section for HIV-infected pregnant women has better analgesia effect with QLB and can reduce the impact on the cellular immunity.
作者
徐学文
李水英
程明静
赵卫兵
Xu Xuewen;Li Shuiying;Cheng Mingjing;Zhao Weibing(Department of Anesthesiology,Chongqing Public Health Medical Center)
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2022年第10期1231-1235,共5页
Journal of Chongqing Medical University
关键词
腰方肌阻滞
腹横肌平面阻滞
HIV感染孕产妇
剖宫产术
镇痛
细胞免疫
quadratus lumborum block
transversus abdominis plane block
human immunodeficiency virus-infected pregnant women
caesarean section
analgesia
cellular immunity
