首页|竖脊肌平面阻滞联合患者自控静脉镇痛用于剖宫产术后镇痛的效果

竖脊肌平面阻滞联合患者自控静脉镇痛用于剖宫产术后镇痛的效果

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目的 评估超声引导下竖脊肌平面阻滞(erector spinae plane block,ESPB)联合患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)用于剖宫产术后镇痛的效果.方法 选取2022年5月至2023年8月在嘉兴市妇幼保健院接受椎管内麻醉下剖宫产的120名足月单胎产妇.按随机数字表法分为三组:E组(ESPB联合PCIA)、T组[腹横肌平面(transversus abdominis plane,TAP)阻滞联合PCIA]及对照组(仅PCIA),每组40名.分别记录术后4h、8h、12h、24h和48h静息和咳嗽时的视觉模拟评分法(visual analogue scale,VAS)及伯格曼舒适度量表(Bruggrmann comfort scale,BCS)评分.记录48h内有效PCIA按压次数、舒芬太尼总给药量、补救镇痛比例及产妇满意度.观察48h内的不良反应和新生儿结局.结果 E组产妇术后8h、12h和24h静息和咳嗽时的VAS评分低于T组,且两组产妇的VAS评分低于对照组,差异有统计学意义(P<0.05).E组产妇术后8h、12h和24h的BCS评分高于T组,且两组BCS评分均高于对照组,差异有统计学意义(P<0.05).E组产妇术后48h内有效PCIA按压次数、补救镇痛比例和舒芬太尼总给药量均低于T组,且两组的上述指标均低于对照组,差异有统计学意义(P<0.05).E组产妇满意度评分高于T组,且两组均高于对照组,差异有统计学意义(P<0.05).三组产妇术后48h内的不良反应和新生儿结局比较,差异均无统计学意义(P>0.05).结论 超声引导下ESPB联合PCIA的镇痛效果优于TAP阻滞联合PCIA,且可减少镇痛药用量并提升产妇的镇痛满意度和舒适度.
Effect of erector spinae plane block combined with patient controlled intravenous analgesia on postoperative analgesia after cesarean section
Objective To assess effect of ultrasound-guided erector spinae plane block(ESPB)combined with patient controlled intravenous analgesia(PCIA)on postoperative analgesia after cesarean section.Methods A total of 120 full-term singleton pregnant women who underwent cesarean section under spinal anesthesia at Jiaxing Maternal and Child Health Care Hospital from May 2022 to August 2023 were selected.Participants were randomly divided into three groups using a random number table:Group E(ESPB combined with PCIA),group T[transversus abdominis plane(TAP)block combined with PCIA],and control group(PCIA alone),with 40 women in each group.Visual analogue scale(VAS)and Bruggrmann comfort scale(BCS)scores during rest and coughing were recorded at 4h,8h,12h,24h,and 48h postoperatively.Number of effective PCIA presses,total sufentanil dosage,proportion of rescue analgesia and maternal satisfaction were also documented within 48h.Additionally,adverse reactions and neonatal outcomes were observed within the same 48h period.Results Postoperatively,VAS scores for rest and coughing in group E at 8h,12h,24h were significantly lower than those in group T,those in two groups were lower than those in control group(P<0.05).Postoperatively at 8h,12h,and 24h,BCS scores in group E were significantly higher than those in group T,with both higher than those in control group(P<0.05).Within 48h after surgery,the number of effective PCIA presses,proportion of rescue analgesia and total sufentanil dosage in group E were lower than those in group T,both lower than those in control(P<0.05).Moreover,maternal satisfaction score in group E was significantly higher than that in group T,that in two groups was significantly higher than that in control group(P<0.05).Within 48h after surgery,there were no significant differences in adverse reactions or neonatal outcomes among the three groups(P>0.05).Conclusion Ultrasound-guided ESPB combined with PCIA outperforms TAP block combined with PCIA,with reducing analgesic dose and enhancing maternal satisfaction and comfort.

Erector spinae plane blockPatient controlled intravenous analgesiaTransversus abdominis plane blockPostoperative analgesiaCaesarean section

姚汉青、黄佳悦、董玉芳、刘林、钱兴华

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嘉兴市妇幼保健院手术麻醉科,浙江嘉兴 314000

竖脊肌平面阻滞 患者自控静脉镇痛 腹横肌平面阻滞 术后镇痛 剖宫产术

浙江省嘉兴市科技计划项目

2022AD30089

2024

中国现代医生
中国医学科学院

中国现代医生

影响因子:1.571
ISSN:1673-9701
年,卷(期):2024.62(24)