超声引导下腹横肌平面阻滞复合氟比洛芬酯或舒芬太尼在剖宫产术后镇痛中的应用效果

摘要

目的:研究超声引导下腹横肌平面阻滞(TAPB)复合氟比洛芬酯或舒芬太尼在剖宫产术后镇痛中的应用效果.方法:选取2018年1—6月在广西医科大学附属武鸣医院行剖宫产手术的120例产妇,按随机数字表法分为A组、B组、C组,每组40例.A组术后超声引导下行双侧TAPB(每侧0.375％ 罗哌卡因25mL)联合静脉自控镇痛(氟比洛芬酯250mg+生理盐水75mL),B组超声引导下行双侧TAPB(每侧0.375％罗哌卡因25mL)联合静脉自控镇痛(舒芬太尼100μg+生理盐水98mL),C组予以单纯自控静脉镇痛(舒芬太尼100μg+生理盐水98mL).分别于术后2h、6h、12h、24h、48h记录视觉模拟评分(VAS)、舒适度评分(BCS)和Ramsay镇静评分,记录48h后镇痛泵药物的用量.比较3组术后恶心、呕吐、呼吸抑制等不良反应的发生率和产妇满意度.结果:与C组比较,A组和B组术后2h、6h、12h、24h、48h的VAS评分、镇痛泵药物用量及不良反应总发生率均明显降低,BCS评分、Ramsay镇静评分及产妇总满意度明显升高,差异均有统计学意义(均P<0.05). A组和B组各指标比较差异均无统计学意义(P>0.05).结论:超声引导下TAPB复合氟比洛芬酯或舒芬太尼在剖宫产术后的镇痛效果良好,可减少镇痛泵药物用量及不良反应的发生,产妇满意度较高.%Objective:To study the effect of ultrasound-guided transverse abdominal plane block (TAPB) combined with flurbiprofen or sulfentanyl on postoperative analgesia after caesarean section.Methods:A total of 120women underwent caesarean section in our hospital from January 2018 to June 2018 were selected, and randomly divided into group A,B and C,with 40cases in each group.Group A women received ultrasound-guided TAPB immediately after surgery combined with flurbiprofen axetil for intravenous patientcontrolled analgesia(PCIA).Group B women received ultrasound-guided TAPB combined with sulfentanyl for PCIA.Group C women only received sulfentanyl for PCIA.After 2h,6h,12h,24h and 48h of surgery, the visual analogue scale(VAS) score,Bruggrmann comfort scale(BCS) score and Ramsay sedation score were recorded.The used dosage of analgesic drugs within 48hpost-operation,the incidence of nausea,vomiting and respiratory inhibition,and the satisfactory rate were compared.Results:The VAS scores at 2h,6h, 12h,24h and 48hpost-operation,the used dosage of analgesic drugs within 48hours and the incidence of adverse reactions in group A and group B were lower than those in group C,while the BCS score,Ramsay sedation score and maternal satisfaction rate were significantly higher(P<0.05).Conclusion:Ultrasoundguided TAPB combined with flurbiprofen or sulfentanyl had good analgesic effect after caesarean section.It could reduce the dosage of analgesic drugs and the incidence of adverse reaction,and increase the satisfaction of analgesia.