文章摘要
超声引导下腹部神经阻滞联合瑞芬太尼输注在血小板减少产妇剖宫产手术中的应用
Clinical applicacation of ultrasound-guided abdomen nerve block combined with remifentanil infusion in cesarean section in patients with thrombocytopenia
  
DOI：
中文关键词: 超声引导  腹部神经阻滞  瑞芬太尼  血小板减少  剖宫产
英文关键词: ultrasound-guided  Abdominal nerve blocktransversus  Remifentanil  Thrombocytopenia  Cesarean delivery
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作者单位E-mail
陈莹莹 238000,合肥市,安徽医科大学附属巢湖医院麻醉科  
夏晓琼 238000,合肥市,安徽医科大学附属巢湖医院麻醉科 xxq2366833@sina.com 
陶志国 238000,合肥市,安徽医科大学附属巢湖医院麻醉科  
夏书江 238000,合肥市,安徽医科大学附属巢湖医院麻醉科  
高翔 238000,合肥市,安徽医科大学附属巢湖医院麻醉科  
王亮 238000,合肥市,安徽医科大学附属巢湖医院麻醉科  
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中文摘要:
      
目的：观察超声引导下腹部神经阻滞联合瑞芬太尼输注在血小板减少产妇剖宫产手术中的应用效果。
方法：选择妊娠合并血小板减少(Plt<7.0×109/L), 术前无早产、无胎儿窘迫, 且初次行剖宫产的产妇60例, 年龄20～32岁, ASA Ⅰ或Ⅱ级, 分为腹横肌平面阻滞、髂腹下-髂腹股沟神经阻滞联合瑞芬太尼组(T组)和全麻组(G组), 每组30例。两组术后均行PCIA。比较两组产妇从切皮至胎儿剖出的时间,麻醉前、切皮即刻及胎儿剖出时的血流动力学变化和术后48 h镇痛泵按压次数。比较胎儿剖出后的Apgar评分。
结果：T组切皮至胎儿剖出时间明显长于G组(P＜0.05), 但两组均在6 min内取出胎儿。与G组比较, 胎儿剖出时T组产妇BP明显上升, HR明显加快(P＜0.05), 但产妇未出现明显不适症状。与G组比较, T组术后48 h镇痛泵按压次数明显减少(P＜0.05), 镇痛效果完善。胎儿剖出后1 min T组新生儿Apgar评分明显高于G组新生儿(P＜0.05)。
结论：超声引导下腹部神经阻滞联合瑞芬太尼输注应用于剖宫产手术时对新生儿影响较小, 术后镇痛效果理想。
英文摘要:
      
Objective: To observe the effect of ultrasound-guided abdomen nerve block combined with remifentanil infusion in cesarean section in patients with thrombocytopenia.
Methods: Sixty parturients recruited for the first cesarean delivery with hrombocytopenia (Plt<7.0×109</L), aged 20-32 years, in ASA physical status Ⅰ or Ⅱ, having no preterm birth and no fetal distress before surgery, were randomly divided into two groups: transversus abdominis plane block, ilioinguinal-iliohypogastric nerve block combined ith remifentanil group (group T) and general anesthesia group (group G). Both groups received atient-controlled intravenous analgesia (PCIA) after cesarean delivery; the delivery time from the cut to the fetus, Apgar score after delivery of the fetus, hemodynamics of the two groups of atients before surgery (T1), immediate cut (T2) and fetal delivery (T3) and 48 h postoperative nalgesic satisfaction were recorded and compared between the two groups.
Results: Compared with group G, the delivery time from the cut to the fetus was extended in group T (P＜0.05), but the fetus were removed within 6 minutes in the two groups. The Apgar score of 1 min after birth of newborns was significantly higher in group T than that in group G (P＜0.05). Compared with group G, the blood pressure and the heart rate had increased at T3 in group T (P＜0.05), but the parturients did not appear obvious symptoms. Compared with group G, the number of successfully delivered doses within 48 h were significantly lower in group T (P＜0.05), TAP guided by sonography had excellent effect.
Conclusion: Ultrasound-guided abdomen nerve block combined with remifentanil infusion in cesarean section has little effect on neonatal, similar anesthesia effect to general anesthesia and obvious postoperative analgesia.
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