CAJ | 학술논문

目的：观察超声引导下腹横肌平面（TAP）阻滞用于剖宫产术患者术后镇痛的效果。方法择期腰硬联合麻醉下行剖宫产术患者60例，ASA分级Ⅰ级或Ⅱ级，分为罗哌卡因组（Ⅰ组）和等量0.9%氯化钠溶液组（Ⅱ组）。手术完成后在超声引导下行双侧TAP阻滞，Ⅰ组每侧注射0.375%罗哌卡因20ml，Ⅱ组每侧注射等容量0.9%氯化钠溶液。术毕所有患者均行经静脉患者自控镇痛（PCIA）。比较两组术后2 h、6 h、12 h、24 h、48 h静态和动态视觉模拟疼痛（VAS）评分，记录两组术后镇痛泵第一次按压时间、24 h镇痛泵按压次数、镇痛满意度、PCIA的用量以及不良反应的发生情况。结果两组术后2 h、6 h、12 h、24 h、48 h的静态VAS评分比较，差异无统计学意义（t分别=1.85、1.96、1.99、1.96、1.63，P均＞0.05）。Ⅰ组术后2 h、6 h、12 h和24 h时点的动态VAS评分明显低于Ⅱ组，差异有统计学意义（t分别=4.46、4.95、5.13、3.08，P均＜0.05）。Ⅰ组术后镇痛泵第一次按压时间比Ⅱ组延迟（t=6.82，P＜0.05），24 h镇痛泵按压次数比Ⅱ组少（t=6.17，P＜0.05），镇痛满意度比Ⅱ组高（χ2=4.32，P＜0.05），术后24 h内PCIA使用量比Ⅱ组更少（t=7.32，P＜0.05）。两组均未见与TAP穿刺相关的并发症，两组术后恶心、呕吐等不良反应发生率的比较，差异无统计学意义（χ2分别=0.23、0.10，P均＞0.05）。结论超声引导下TAP阻滞用于剖宫产术患者的术后镇痛效果好，减少了PCIA的需要量。
목적：관찰초성인도하복횡기평면（TAP）조체용우부궁산술환자술후진통적효과。방법택기요경연합마취하행부궁산술환자60례，ASA분급Ⅰ급혹Ⅱ급，분위라고잡인조（Ⅰ조）화등량0.9%록화납용액조（Ⅱ조）。수술완성후재초성인도하행쌍측TAP조체，Ⅰ조매측주사0.375%라고잡인20ml，Ⅱ조매측주사등용량0.9%록화납용액。술필소유환자균행경정맥환자자공진통（PCIA）。비교량조술후2 h、6 h、12 h、24 h、48 h정태화동태시각모의동통（VAS）평분，기록량조술후진통빙제일차안압시간、24 h진통빙안압차수、진통만의도、PCIA적용량이급불량반응적발생정황。결과량조술후2 h、6 h、12 h、24 h、48 h적정태VAS평분비교，차이무통계학의의（t분별=1.85、1.96、1.99、1.96、1.63，P균＞0.05）。Ⅰ조술후2 h、6 h、12 h화24 h시점적동태VAS평분명현저우Ⅱ조，차이유통계학의의（t분별=4.46、4.95、5.13、3.08，P균＜0.05）。Ⅰ조술후진통빙제일차안압시간비Ⅱ조연지（t=6.82，P＜0.05），24 h진통빙안압차수비Ⅱ조소（t=6.17，P＜0.05），진통만의도비Ⅱ조고（χ2=4.32，P＜0.05），술후24 h내PCIA사용량비Ⅱ조경소（t=7.32，P＜0.05）。량조균미견여TAP천자상관적병발증，량조술후악심、구토등불량반응발생솔적비교，차이무통계학의의（χ2분별=0.23、0.10，P균＞0.05）。결론초성인도하TAP조체용우부궁산술환자적술후진통효과호，감소료PCIA적수요량。
Objective To observe the efficacy of ultrasound-guided transversus abdominis plane (TAP) block for post-operative analgesia in patients with caesarean delivery. Medthods Sixty ASAⅠ-Ⅱ patients that scheduled for elective caesarean delivery under combined spinal-epidural anesthesia were randomly divided into two groups with 30 cases in each: ropivacaine group (groupⅠ) and same volume saline group (groupⅡ). The ultrasound-guided bilateral TAP block was performed at the end of surgery, and 0.375%ropivacaine 20 ml was injected to each side in group Ⅰ while the equal volume of normal saline was injected in group Ⅱ. After that, all patients received patient controlled intravenous analgesia (PCIA). The visual analogue scale (VAS) scores at 2-hour, 6-hour, 12-hour, 24-hour and 48-hour at rest and move-ment, the time to require the first bolus, and the numbers of bolus in 24 hours, the satisfaction on analgesia, total con-sumption of PCIA and the adverse reactions were all recorded and compared. Results The VAS scores at rest of two groups were not statistical different at 2-hour, 6-hour, 12-hour, 24-hour and 48-hour (t=1.85, 1.96, 1.99, 1.96, 1.63, P>0.05). The VAS scores at movement in groupⅠwere significantly lower at 2-hour, 6-hour, 12-hour and 24-hour af-ter operation than groupⅡ (t=4.46, 4.95, 5.13, 3.08, P<0.05). In groupⅠ, the time to require the first bolus was sig-nificantly longer than group Ⅱ(t=6.82,P<0.05), the compression numbers were significantly less(t=6.17,P<0.05), the satisfaction on analgesia were significantly better (χ2=4.32,P<0.05) and the consumption of PCIA were significantly lower (t=7.32, P<0.05). TAP block-related complications were not found in two groups, and the incidence of postoperative nausea,vomiting had no statistic differences (χ2=0.23, 0.10,P>0.05). Conclusion Ultrasound-guided TAP block for postoperative analgesia is effective in patients with elective caesarean delivery and the requirement of PCIA analgesics is decreased.