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目的观察超声引导下腹横肌平面(transversus abdominis plane,TAP)阻滞用于剖宫产腰麻硬膜外联合麻醉时的效果。方法腰麻硬膜外联合麻醉下行剖宫产术患者150例,随机分为两组:A组行腰麻硬膜外联合麻醉+TAP阻滞麻醉,B组行腰麻硬膜外联合麻醉+超声引导TAP阻滞麻醉,各75例。两组患者均采用腰麻硬膜外联合麻醉,记录患者术中不同时间点的平均动脉压(mean artery pressure,MAP)、心率(heart rate,HR)、疼痛评分以及术中牵拉反射发生率,同时观察并记录患者手术结束后2小时、4小时、8小时、16小时、24小时、36小时的疼痛评分、术后不良反应发生率、患者术后镇痛泵按压次数以及患者首次下地活动时间。结果 B组患者术中不同时间点MAP、HR的变化以及疼痛评分优于A组(P<0.05);B组患者术中牵拉反射发生率明显低于A组(P<0.05);两组患者术后2小时的疼痛评分比较差异无统计学意义(P>0.05),但是B组患者术后4—36小时的疼痛评分明显优于A组(P<0.05),B组患者术后不良反应发生率以及镇痛泵按压次数也少于A组(P<0.05);B组患者首次下地活动时间明显提前于A组(P<0.05)。结论超声引导下TAP阻滞用于剖宫产腰硬联合麻醉时成功率高,麻醉效果更加确切,不良反应少且术后持续镇痛效果好。
Objective To observe the effect of ultrasound-guided transversus abdominis plane (TAP) blockade on spinal anesthesia during cesarean section. Methods 150 cases of cesarean section under spinal anesthesia and epidural anesthesia were randomly divided into two groups: group A received spinal anesthesia + TAP block anesthesia, group B received spinal anesthesia combined with epidural anesthesia + Ultrasound-guided TAP block anesthesia, 75 cases each. Both groups received spinal anesthesia combined with epidural anesthesia. The mean arterial pressure (MAP), heart rate (HR), pain score and incidence of intraoperative traction and reflex were recorded at different time points during operation. At the same time, we observed and recorded the pain scores of patients at 2, 4, 8, 16, 24, 36 hours after surgery, the incidence of postoperative adverse reactions, the number of postoperative analgesia pumps and the first time time. Results The changes of MAP, HR and pain in group B were better than those in group A at different time points (P <0.05). The incidence of intraoperative stretch in group B was significantly lower than that in group A (P <0.05) There was no significant difference in pain score between two hours postoperatively (P> 0.05), but the pain scores of patients in group B were significantly better than those in group A (P <0.05) The incidence of the reaction and the number of analgesia pump press were also less than those in group A (P <0.05). The first time of lower body movement in group B was significantly earlier than that in group A (P <0.05). Conclusion TAP blockade guided by ultrasound is more effective in cesarean section combined spinal-epidural anesthesia. The anesthesia effect is more accurate, the adverse reaction is less and the analgesic effect after operation is good.