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剖宫产术I-TAP阻滞应用对术后的镇痛效果

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目的:探讨髂腹股沟-腹横肌平面(I-TAP)阻滞与腹横肌平面(TAP)阻滞对剖宫产产妇术后镇痛效果的影响.方法:将2021年4月-2023年3月在本院产科计划剖宫产分娩的86例产妇随机分成TAP组与I-TAP组各43例,分别采用TAP阻滞麻醉或I-TAP阻滞麻醉.观察两组术后疼痛程度(VAS评分)、自控镇痛(PCA)按压次数、血清泌乳素(PRL)水平、不良反应.结果:I-TAP组VAS评分术后2h(1.29±0.32分)、4h(2.02±0.53分)、8h(2.84± 0.82分)、16h(2.31±0.72 分)、24h(2.33±0.52 分)均低于 TAP 组(1.67±0.46 分、2.55±0.70 分、3.62±1.00 分、2.97± 0.81分、2.65±0.74分),PCA总按压次数(12.12±2.69次)、PCA有效按压次数(5.88±1.46次)均少于TAP组(14.46 ±4.57次、7.03±1.25次),两组术后1d血清PRL水平均升高,且I-TAP组(318.26±40.15μg/L)高于TAP组(251.65 ±32.67μg/L);不良反应发生率(9.3%)与TAP组(14.0%)无差异(P>0.05).结论:I-TAP阻滞在剖宫产术麻醉中的应用效果优于TAP阻滞,可减轻产妇术后疼痛,减少PCA按压次数,提高术后PRL水平,且不良反应少,有效性与安全性均较好,值得应用.
Influence of ilioinguinal transversus abdominis block used in cesarean section of women on their postoperative analgesia
Objective:To investigate the influence of ilioinguinal transversus abdominis plane(I-TAP)block and trans-versus abdominis plane(TAP)block used in cesarean section of women on their postoperative analgesia.Methods:86 pregnant women who wanted cesarean section were randomly divided into two groups from April 2021 to March 2023.43 women in group A received TAP block anesthesia,while 43 women in group B received I-TAP block anesthesia.The postoperative pain degree evaluated by VAS score,the compression number of patient-controlled analgesia(PCA),the prolactin level and the adverse reactions rate of the women in the two groups were observed.Results:The VAS scores of the women in group B at 2h after surgery(1.29±0.32 points),at 4h after surgery(2.02±0.53 points),at 8h after surgery(2.84±0.82)points,at 16h after surgery(2.31±0.72 points)and at 24h after surgery(2.33±0.52 points)were significantly lower than those(1.67±0.46 points,2.55±0.70 points,3.62±1.00 points,2.97±0.81 points and 2.65±0.74 points)of the women in group A.The total number of the PCA presses(12.12±2.69 times)and the number of the effective PCA presses(5.88±1.46 times)of the women in group B were significantly less than those(14.46±4.57 times and 7.03±1.25 times)in group A.The serum PRL level of the women in the two groups in the first day after operation had increased significantly,and which(318.26±40.15 mu g/L)of the women in group B was significantly higher than that(251.65±32.67 mu g/L)of the women in group A.There was no significant difference in the incidence of adverse reactions(9.3%vs.14.0%)of the women between the two groups(P>0.05).Conclusion:The application effect of I-TAP block for anesthesia in cesarean section of the women is superior to that of TAP block,which can reduce the postoperative pain,reduce the number of PCA compressions,improve the postoperative prolactin level and has fewer adverse reactions of the women,with the high effectiveness and safety,and which is worth of application in clinic.

Cesarean sectionIlioinguinal transversus abdominis plane blockTransversus abdominis plane blockPostoperative analgesiaProlactinAdverse reactions

董晓莉、吴继敏、岳松涛

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浙江中医药大学研究生院(杭州,310053)

浙江省丽水市人民医院

剖宫产术 I-TAP阻滞 TAP阻滞 术后镇痛 泌乳素 不良反应

浙江省医药卫生科技项目

2023KY428

2024

中国计划生育学杂志
国家人口计生委科学技术研究所

中国计划生育学杂志

CSTPCD
影响因子:1.759
ISSN:1004-8189
年,卷(期):2024.32(2)
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