地塞米松对罗哌卡因用于剖宫产术后TAP阻滞镇痛效果的影响

摘要

目的：观察地塞米松对罗哌卡因用于剖宫产术后腹横肌平面（transversus abdominis plane，TAP）阻滞时间和效果的影响。方法将2013年7月至2014年5月间首都医科大学附属北京妇产医院收治的90例剖宫产产妇随机均分为三组，对照组（C组），罗哌卡因组（R组），地塞米松+罗哌卡因组（DR组）。术毕DR组和R组行TAP阻滞。记录所有产妇术后2小时、4小时、6小时、8小时、10小时、24小时、26小时、28小时静息和活动疼痛评分，镇痛泵药物用量，腹部温度觉平面恢复率，术后恶心呕吐评分，TAP并发症。结果①三组术后2小时、4小时、6小时、8小时、10小时静息疼痛、活动疼痛评分差异具有显著性（P＜0.05）；24小时后差异无显著性（P＞0.05）。②术后4小时、6小时、8小时、10小时、24小时DR组和R组镇痛泵药物用量低于C组（P＜0.05）；术后24小时DR组镇痛泵药物用量低于R组（P＜0.05）。③术后2小时、4小时、6小时、8小时、10小时、24小时三组腹壁温度觉恢复率差异具有显著性（P＜0.05），DR组低于R组，R组低于C组；术后26小时、28小时三组差异无显著性（P＞0.05）。④C组术后排气时间较长（P＜0.05）。⑤C组术后恶心呕吐发生率高于其他两组（P＜0.05）。结论地塞米松可延长罗哌卡因用于剖宫产术后TAP阻滞镇痛的时间和增强镇痛效果。%Objective To observe and evaluate duration and effect of adding dexamethasone to ropivacaine in transversus abdominis plane (TAP) block after caesarean section.MethodBetween July 2013 to May 2014, 90 cases of cesarean section were randomly divided into three groups in the affiliated Beijing Obstetrics and Gynecolcgy Hospital of Capital Medical University (n=30 each), control group (group C), ropivacaine group (group R), dexamethasone and ropivacaine group (group DR). Group C was not given TAP block, Group R was performed with 20 ml of 0.4% ropivacaine, Group DR was 0.4% ropivacaine added 5mg dexamethasone co 20ml, The resting and motion VAS of pain were assessed after the surgery at 2h, 4h, 6h, 8h, 10h, 24h, 26h, 28h. Analgesic consumption, the recovery of abdominal wall temperature sensation, postoperative exhaust time, nausea and vomiting score, and TAP related complications were recorded.Result①Postoperative resting and motion VAS of pain at 2h, 4h, 6h, 8h, 10h were significantly different (P<0.05),but not different at 24h, 26h, 28h (P>0.05).②Analgesia drug usage in group DR and group R were lower than that of group C at 4h, 6h, 8h, 10h and 24h(P<0.05); at 24h the dosage of DR was lower than group R(P<0.05).③The recovery rate of abdominal wall temperature sensation among the three groups were significantly different at 2h, 4h, 6h, 8h, 10h, 24h(P<0.05), but not different at 26 and 28h (P>0.05).④The postoperative exhaust time was not different between group DR and group R , and both of which were earlier than that of group C(P<0.05).⑤The rate of nausea and vomiting was higher in group C than in the other two groups (P<0.05).Conclusion Dexamethasone could prolong and improve the analgesic effect of ropivacaine in TAP block after cesarean section.