【摘要】 目的:探讨纳布啡复合罗哌卡因腹横肌平面阻滞用于剖宫产术后镇痛效果。方法:将60例在腰硬联合麻醉下剖宫产的经产妇分为两组,行腹横肌平面(TAP)阻滞:0.25%罗哌卡因(R组30例)和0.25%罗哌卡因+40 mg纳布啡(RN组30例)。术毕所有患者超声引导下双侧腹横肌平面阻滞,并连接静脉镇痛泵(PCIA)。记录两组术后2、6、12、24、48 h的静息及咳嗽疼痛评分(VAS评分)、Ramsay镇静评分;记录两组术后24 h PCIA舒芬太尼总消耗量及术后PCIA首次按压时间、术后肛门排气时间、拔除导尿管后首次排尿时间;记录不良反应发生情况及镇痛满意度评分情况。结果:RN组与R组比较,术后2、6、12 h时静息VAS评分较低(P<0.05);术后2、6、12、24 h时咳嗽VAS评分较低,Ramsay镇静评分较高(P均<0.05)。RN组术后24 h与R组比较,PCIA中舒芬太尼总消耗量减少,距离手术结束首次按压PCIA时间延长,术后通气时间、拔出导尿管后首次排尿时间缩短(P均<0.05)。RN组术后48 h与R组比较,恶心呕吐及寒颤反应发生率降低,镇痛满意度评分升高(P均<0.05);两组均未见与腹横肌平面阻滞操作引起的血肿、感染等不良反应。结论:与单纯罗哌卡因相比,纳布啡复合罗哌卡因腹横肌平面阻滞能强化剖宫产术后的镇痛效果,提高患者满意度。更多还原

【Abstract】 Objective:To investigate the analgesia effect of nalbuphine as an adjuvant to ropivacaine in transversus abdominis plane(TAP)block in women following cesarean section.Methods:Sixty pluripara undergoing elective cesarean delivery by combined spinal and epidural anesthesia were recruited and randomized into two groups.Women in group R(n=30) underwent post-operative TAP block using single 0.25% ropivacaine,and those in group RN(n=30) were given 0.25% ropivacaine plus 40 mg nalbuphine.After cesarean delivery,all patients received ultrasound guided bilateral TAP block,and patient-controlled intravenous analgesia(PCIA).The indicators,including pain scoring on VAS at resting and coughing as well as Ramsay sedation scoring at 2,6,12,24 and 48 h after surgery,total dose of sulfentanil,time to the initial use of PCIA,anal exhaust after surgery,the first autonomic micturition after removal of the catheter,incidence of adverse reactions and patient satisfaction,were maintained and compared between the two groups.Results:Women in the group RN had significantly lowered VAS scoring at resting at 2,6,and 12 h,and at cough at 2,6,12,and 24 h following operation,yet higher scoring for Ramsay sedation(all P<0.05).Reduced total dose of sufentanil and delayed initiation of PCIA,earlier postoperative anal exhaust,removal of the catheter and automatic micturition were observed at 24 h after surgery,and significantly decreased adverse response including nausea,vomiting and chilly yet higher satisfaction rate with the analgesia were recorded at 48 h following surgery in group RN(all P<0.05).No complications such as hematomas and infections related to TAP block occurred in both groups.Conclusion:Combined use of nalpuphine with ropivacaine can lead to better analgesia effect than single dose of ropivacaine and higher satisfaction in women undergone cesarean section.更多还原