超声引导腰方肌阻滞对剖宫产术后镇痛的影响#br#

doi:10.3969/j.issn.10073205.2018.09.014

摘要/Abstract

摘要： ［摘要］〓
〖HTH〗目的〖HTSS〗〖KG*2〗探讨超声引导腰方肌阻滞（quadratus lumborum block，QLB）对剖宫产术术后镇痛效果的影响。
〖HTH〗方法〖HTSS〗〖KG*2〗选择择期行足月剖宫产术产妇60 例，随机分为QLB组（Q组）和对照组（C组）各30例。2组均采用腰硬联合麻醉，术后均行经静脉患者自控镇痛(patient controlled intravenous analgesia,PCIA)。Q组于术毕行超声引导双侧QLB，每侧注射0.25%罗哌卡因30 mL，C组不阻滞。记录手术时间、术中补液量、出血量及尿量。记录2组术后2，4，8，12，24，36，48 h静息和运动时VAS评分；记录术后首次按压镇痛泵时间、48 h内镇痛泵有效按压次数/实际按压次数比（D1/D2）和舒芬太尼用量；记录术后恢复情况；术后48 h随访并记录产妇对镇痛效果的满意度和镇痛期间不良反应发生情况。
〖HTH〗结果〖HTSS〗〖KG*2〗2组各时点静息和运动VAS评分均呈逐渐上升再下降趋势，且Q组低于C组，组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜005）。Q组术后首次按压镇痛泵时间明显延长，D1/D2明显升高，术后48 h内舒芬太尼用量明显减少（P＜005）。Q组术后首次排气时间、进食普通食物时间、下床活动时间明显缩短（P＜005）。Q组产妇对镇痛的满意度明显升高（P＜005）。
〖HTH〗结论〖HTSS〗〖KG*2〗剖宫产术后实施超声引导QLB镇痛效果确切，能显著缓解产妇术后疼痛，减少阿片类药物使用，促进产妇快速康复同时提高满意度。

关键词: 麻醉和镇痛, 剖宫产术, 病人满意度

Abstract: ［Abstract］ Objective〖HTSS〗〓To investigate the effect of ultrasoundguided quadratus lumborum block(QLB) on the efficacy postoperative analgesia in parturient woman undergoing caesarean delivery.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓There were 60 parturient in this study who were underwent full term cesarean section. Parturient woman were randomly divided into two groups:QLB group(Q group, n=30) and control group(C group, n=30).Two groups were treated by combined spinal epidural anesthesia, and all parturient woman were treated with PCIA after operation.After cesarean delivery,bilateral of ultrasoundguided QLB were performed,30 ml of 0.25% ropivacaine was injected in each side in Q group, while QLB was not done in C group. The time of operation, the amount of fluid infusion, the amount of bleeding and the volume of urine were recorded. The scores of resting and exercise VAS were recorded at 2, 4, 8, 12, 24, 36 and 48 h after operation.The time of the first press analgesia pump, the number of successfully doses(D1) and the number of attempts(D2) within 48 h, the amount of sufentanil within 48 h were recorded. D1/D2 was calculated. Postoperative recovery was recorded. The satisfaction of the parturient woman on the analgesic effect and the adverse reaction during the analgesia period were recorded at 48 hr postoperatively.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The VAS scores of the two groups at each time point were gradually rising and then decreasing, and the Q group was lower than the C group. The differences between intergroup, time point and interaction of intergroup and time point of two groups had the statistically significant. The first exhaust time,the time to eat ordinary food and the time to get out of bed after the operation were significantly lower,while the time of the first press analgesia pump, the value of D1/D2, the degree of satisfaction with analgesia were significantly higher in the Q group than those in C group(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓After cesarean section, the effect of ultrasoundguided QLB analgesia is accurate, which can significantly alleviate the postoperative pain, reduce the use of opioids, promote rapid recovery of maternal and improve satisfaction.

Key words: anesthesia and analgesia, cesarean section； patient satisfaction

张隆盛，林旭林，张欢楷，杨〓铎，林耿彬，黄志良. 超声引导腰方肌阻滞对剖宫产术后镇痛的影响#br#[J]. 河北医科大学学报, doi: 10.3969/j.issn.10073205.2018.09.014.

ZHANG Longsheng, LIN Xulin, ZHANG Huankai, YANG Duo, LIN Gengbin, HUANG Zhiliang. Effect of ultrasoundguided quadratus lumborum block on postoperative analgesia in parturient woman undergoing caesarean delivery[J]. Journal of Hebei Medical University, doi: 10.3969/j.issn.10073205.2018.09.014.

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超声引导腰方肌阻滞对剖宫产术后镇痛的影响#br#

Effect of ultrasoundguided quadratus lumborum block on postoperative analgesia in parturient woman undergoing caesarean delivery

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