横肌平面阻滞用于肝功能障碍产妇剖宫产术后镇痛效果观察

摘要

Objective To compared the analgesic efficacy of transversus abdominis plane (TAP) blocks ap-plied in parturient accompanied with liver dysfunction after cesarean delivery. Methods Thirty parturients with liver dysfunction who underwent cesarean delivery under general anesthesia were allocated randomly into two groups, with 15 cases in each group. The parturients in observation group received bilaterally transversus abdominis plane block with 40 ml of 0.25%levobupivacaine under ultrasound guidance at the end of surgery when the patients were still under gen-eral anesthesia. The parturients in control group received no block. The dosage of intravenous sufentanil use for 24 h, pain scores at rest and activity 2 h, 4 h, 6 h, 12 h, 24 h after surgery. Vomiting, nausea and the time of first postoperative ambulation and flatus were recorded. Results Patients in observation group used significantly less sufentanil in 24 h than those in the control group (P<0.05). There were no differences between the two groups in pain visual analogue scale (VAS) scores at 2 h postoperative (P>0.05). Pain VAS score at activity of observation group was significantly lower than that of control group at 4 h postoperative (P<0.05), while pain VAS score at rest showed no significant difference (P>0.05). Pain VAS score of observation group at rest and activity were significantly lower than those of control group at 6 h, 12 h and 24 h postoperative (P<0.05) . The incidence of postoperative nausea of observation group was significantly less than that of control group (P<0.05), but no significant difference was found in the incidence of vomiting (P>0.05). The duration of first postoperative ambulation and flatus of observation group was significantly shorter than that of con-trol group (P<0.05). Conclusion TAP block reduces sufentanil consumption, lowers postoperative pain VAS scores and incidence of postoperative nausea, and shortens the duration of first postoperative ambulation and flatus following cesarean section under general anesthesia in parturients who accompanied with liver dysfunction.%目的：观察腹横肌平面(TAP)阻滞用于肝功能障碍的产妇剖宫产术后镇痛的效果。方法选择30例肝功能异常拟行剖宫产的患者，随机分为两组，每组15例。观察组以0.25%左布比卡因40 ml行TAP阻滞；对照组不进行TAP阻滞。全麻下行剖宫产术，术毕缝皮后，观察组在超声引导下行双侧TAP阻滞，记录两组患者术后2h、4h、6h、12h和24h静息及活动的疼痛VAS评分以及24h内舒芬太尼的消耗量，观察两组患者的恶心和呕吐情况、肠蠕动恢复的时间和手术结束至患者首次下地活动所需的时间。结果观察组24 h舒芬太尼总量明显低于对照组(P<0.05)；两组患者术后2 h测VAS评分差异无统计学意义(P>0.05)，观察组在术后4 h运动疼痛VAS评分显著低于对照组(P<0.05)，而静息疼痛VAS评分两组差异无统计学意义(P>0.05)；在术后6 h、12 h和24 h静息及运动疼痛VAS评分观察组均低于对照组(P<0.05)；观察组患者术后首次下地时间和排气时间明显提前(P<0.05)；观察组恶心发生率比对照组低(P<0.05)，而呕吐发生情况差异无统计学意义(P>0.05)。结论超声引导下的TAP阻滞能有效降低肝功能障碍的产妇全麻剖宫产术后的疼痛VAS评分，减少舒芬太尼的用量，降低术后恶心的发生率，缩短了患者术后首次下地时间和排气时间。