文章摘要
超声引导下腹横筋膜平面阻滞与腹横肌平面阻滞在剖宫产术后镇痛中的效果比较
Comparison of effects of ultrasound-guided transversalis fascia plane block and transversus abdominis plane block for cesarean section
  
DOI：10.12089/jca.2020.10.012
中文关键词: 超声检查  腹横筋膜平面阻滞  腹横肌平面阻滞  产科  镇痛
英文关键词: Ultrasonography  Transversalis fascia plane block  Transversus abdominis plane block  Obstetrics  Analgesia
基金项目:
作者单位E-mail
单涛 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
尹骏 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
孟庆胜 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
石莉 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
韩流 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
鲍红光 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 hongguang_bao@163.com 
摘要点击次数: 3045
全文下载次数: 933
中文摘要:
      
目的 比较超声引导下腹横筋膜平面(TFP)阻滞与腹横肌平面(TAP)阻滞在剖宫产术后镇痛中的效果。
方法 择期蛛网膜下腔阻滞下行剖宫产术产妇60例，年龄20～35岁，体重50～75 kg，ASA Ⅰ或Ⅱ级，采用随机数字表法分为两组：腹横筋膜平面阻滞组（TFP组）和腹横肌平面阻滞组（TAP组），每组29例。术毕TFP组行超声引导下双侧腹横筋膜平面阻滞，TAP组行超声引导下双侧腹横肌平面阻滞，两组均每侧注射0.375%罗哌卡因1.25 mg/kg。术后均行曲马多PCIA，若VAS疼痛评分≥4分，肌肉注射曲马多100 mg行补救镇痛。记录术后6、12、24、36、48 h PCIA中曲马多累积用量；记录术后48 h内曲马多补救镇痛情况；记录镇痛期间恶心呕吐、局麻药中毒、呼吸抑制、穿刺部位血肿、穿刺部位感染、腹膜刺穿造成腹腔内注射等不良反应的发生情况。
结果 与TAP组比较，TFP组术后6、12、24、36、48 h PCIA中曲马多累积用量明显减少 （P＜0.05），术后48 h内曲马多补救镇痛率明显降低 （P＜0.05）。两组镇痛期间恶心呕吐发生率差异统计学意义。两组均无其他不良反应发生。
结论 与超声引导下腹横肌平面阻滞比较，腹横筋膜平面阻滞可减少剖宫产术后阿片类药物用量，镇痛效果更佳。
英文摘要:
      
Ojective To compare the analgesic effect of ultrasound-guided transversalis fascia plane block and transversus abdominis plane block after cesarean section.
Methods Sixty parturients undergoing cesarean section under elective subarachnoid block, aged 20-35 years, weighing 50-75 kg, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups (n = 29): transversalis fascia plane block group (group TFP) and transverse abdominis plane block group (group TAP). After operation, ultrasound-guided bilateral transversalis fascia plane block and bilateral transverse abdominal muscle plane block was performed in group TFP and group TAP, respectively, with 0.375% ropivacaine 1.25 mg/kg injected on each side. All the patients received patient-controlled intravenous analgesia with tramadol after surgery. Tramadol 100 mg was injected intramuscularly as rescue analgesic if the VAS score was more than 4 points. The cumulative consumption of tramadol and the relief 6, 12, 24, 36, and 48 hours after operation were recorded. The occurrence of adverse reactions such as nausea and vomiting, local anesthetic poisoning, respiratory depression, puncture site hematoma, puncture site infection, and intraperitoneal puncture caused by intraperitoneal injection during analgesia were recorded. Adverse reactions such as nausea and vomiting during analgesic period were also recorded.
Results Compared with group TAP, the cumulative consumption of tramadol and rate of rescue analgesia in group TFP decreased significantly during analgesia (P < 0.05). There was no significant difference in the incidence of nausea and vomiting. Other adverse reactions were not found in both groups.
Conclusion Compared with transversus abdominis plane block, ultrasound-guided transversalis fascia plane block can reduce the consumption of opioids after cesarean section and enhance analgesic effect of parturients.
查看全文   查看/发表评论  下载PDF阅读器
关闭