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| 舒芬太尼或羟考酮自控静脉镇痛联合腰方肌阻滞用于剖宫产术后镇痛的效果 |
| Analgesic effect of patient-controlled intravenous analgesia with sufentanil or oxycodone combined with quadratus lumborum block after caesarean section |
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| DOI：10.12089/jca.2020.02.004 |
| 中文关键词: 腰方肌阻滞 羟考酮 镇痛 剖宫产 |
| 英文关键词: Quadratus lumborum block Oxycodone Analgesia Caesarean |
| 基金项目: |
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| 中文摘要: |
目的 评价超声引导下腰方肌阻滞(quadratus lumborum block,QLB)联合舒芬太尼或羟考酮PCIA用于剖宫产术后镇痛的效果。
方法 择期在腰-硬联合阻滞下行剖宫产术的产妇120例,年龄22～38岁,体重50～80 kg,ASA Ⅰ或Ⅱ级,采用随机数字表法分为四组,每组30例:舒芬太尼组(S组)、羟考酮组(Q组)、QLB联合舒芬太尼组(BS组)和QLB联合羟考酮组(BQ组)。BS组和BQ组术毕行超声引导下双侧QLB,每侧注射0.25％罗哌卡因20 ml。四组术后均行PCIA,S组和BS组镇痛泵药物为舒芬太尼100 μg加生理盐水至100 ml,Q组和BQ组镇痛泵药物为羟考酮50 mg加生理盐水至100 ml。设置镇痛泵背景输注速率2 ml／h,单次剂量2 ml,锁定时间10 min。记录术后24 h内PCIA给药总量、有效按压次数、补救镇痛情况和镇痛满意度评分。记录镇痛期间恶心呕吐、呼吸抑制、皮肤瘙痒等不良反应的发生情况。
结果 与S组比较,Q组、BS组和BQ组PCIA给药总量、有效按压次数明显减少,镇痛满意度评分明显升高(P＜0.05),Q组术后恶心呕吐发生率明显降低(P＜0.05),BS组和BQ组补救镇痛率明显降低(P＜0.05)。与Q组比较,BS组和BQ组PCIA给药总量、有效按压次数明显减少,补救镇痛率明显降低,镇痛满意度评分明显升高(P＜0.05)。与BS组比较,BQ组PCIA给药总量、有效按压次数明显减少,镇痛满意度评分明显升高,术后恶心呕吐发生率明显降低(P＜0.05)。
结论 超声引导下QLB可增强剖宫产术后镇痛效果,减少术后镇痛药物用量,提高产妇满意度,联合羟考酮PCIA可更有效抑制术后宫缩痛,并降低术后恶心呕吐的发生率。 |
| 英文摘要: |
Ojective To evaluate the analgesic effect of ultrasound-guided quadratus lumborum block (QLB) combined with patient-controlled intravenous analgesia (PCIA) with sufentanil or oxycodone after caesarean section.
Methods One hundred and twenty parturients scheduled for elective cesarean section under combined spinal and epidural anesthesia, aged 22-38 years, weighing 50-80 kg, falling into ASA physical status Ⅰ or Ⅱ, were divided into four groups (n = 30) using a random number table: sufentanil group (group S), oxycodone group (group Q), QLB combined with sufentanil group (group BS) and QLB combined with oxycodone group (group BQ). Parturients in groups BS and BQ received bilateral ultrasound-guided QLB with the use of 20 ml 0.25％ ropivacaine per side after surgery. All the four groups received PCIA postoperatively, groups S and BS were given sufentanil 100 μg in 100 ml normal saline, and groups Q and BQ were given oxycodone 50 mg in 100 ml normal saline. The analgesic pump was set up with background infusion at a rate of 2 ml／h, a 2 ml bolus dose and a 10 min lockout interval. The total analgesic consumption during PCIA, the number of successfully delivered doses, the requirement for rescue analgesia and the satisfaction score of analgesia were recorded within 24 h after surgery. The adverse reactions such as nausea and vomiting, respiratory depression, pruritus during analgesia were also recorded.
Results Compared with group S, the total analgesic consumption during PCIA and the number of successfully delivered doses were significantly decreased, the satisfaction score of analgesia was higher in groups Q, BS and BQ, and the incidence of postoperative nausea and vomiting was significantly decreased in group Q (P ＜ 0.05), and the requirement for rescue analgesia was significantly decreased in groups BS and BQ (P ＜ 0.05). Compared with group Q, the total analgesic consumption during PCIA, the number of successfully delivered doses and the requirement for rescue analgesic were significantly decreased, and the satisfaction score of analgesia was significantly higher in groups BS and BQ (P ＜ 0.05). Compared with group BS, the total analgesic consumption during PCIA, the number of successfully delivered doses, and the incidence of postoperative nausea and vomiting were significantly decreased, the satisfaction score of analgesia was significantly higher in group BQ (P ＜ 0.05).
Conclusion Ultrasound-guided QLB can enhance the analgesic effect after caesarean section, reduce the analgesic consumption after surgery and improve the satisfaction for parturients, ultrasound-guided QLB combined with oxycodone PCIA can suppress the pain of uterine cramping more effectively after surgery and decrease the incidence of postoperative nausea and vomiting. |
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