TAP联合不同浓度舒芬太尼行自控静脉镇痛在产科快速康复中的应用价值

目的 观察超声引导下双侧腹横肌平面阻滞（TAP）联合不同浓度的舒芬太尼行自控静脉镇痛(PCIA)对剖宫产术后疼痛及催乳素的影响，评价其在产科快速康复中的应用价值。方法 选择2020年5月—2021年12月我院择期行剖宫产的产妇96例为研究对象。采用随机数字表分为3组，每组32例，3组产妇术后均在超声引导下行双侧TAP，并分别给予浓度0.50 ug/mL(S1组), 0.75 ug/mL(S2组),1.00 ug/mL(S3组)的舒芬太尼行自控静脉镇痛(PCIA)。分别记录术后4、8、24、48 h产妇静息、运动状态下切口痛的VAS评分、宫缩痛的VAS评分，术前10 min及术后24、48 h产妇血清催乳素（PRL）水平，记录首次下床时间、排气时间、自行排尿时间，记录术后不良反应等。结果 S2组、S3组术后8、24 h切口静息VAS评分明显低于S1组（P<0.05），且在术后8、24、48 h切口活动痛和宫缩痛的VAS评分均明显低于S1组（P<0.05）；S2组S3组术后24、48 h血清PRL浓度高于S1组（P<0.05）；S3组术后排气时间（39.49±6.01） h、恶心呕吐发生率（26.7%）明显高于S1组和S2组（P<0.05）。结论 超声引导下的TAP联合0.75 ug/mL的舒芬太尼行PCIA用于剖宫产,术后镇痛效果好，对催乳素分泌影响小，且胃肠道恢复快，不良反应更少，是推动快速康复外科理念在剖宫产围术期应用的一种多模式镇痛方法

Role of TAP combined with PCIA with different concentrations of sufentanil in enhanced recovery after cesarean section

Objective To observe the effect of ultrasound-guided bilateral transverse abdominal muscle block (TAP) combined with PCIA with different concentrations of sufentanil on postoperative analgesia and the prolactin level after cesarean section, and evaluate its role in enhanced recovery after surgery (ERAS). Methods Ninety-six puerperae scheduled for cesarean section from May 2020 to December 2021 were randomly divided into 3 groups using a random number table. The three groups all received TAP under the guidance of ultrasound, and a patient-controlled intravenous analgesia (PCIA) with 0.5 ug/ml (S1 group, n=32), 0.75 ug/ml (S2 group, n=32), 1ug/ml (S3 group, n=32) sufentanil was used after surgery. The visual analogue scale (VAS) score of incision pain in resting state and exercise state and VAS score of contractions pain were recorded respectively at 4, 8, 24, and 48 h after operation. The serum level of prolactin at 10 minutes before surgery, 24, 48 h postoperatively were detected, respectively. The leaving bed time, the intestinal exhaust time, the first urination time, and the adverse reaction occurred after the surgery were all recorded. Results The VAS scores of incision pain at rest of group S2 and group S3 were lower than group S1 at 8,24 h after surgery (P<0.05). The VAS scores of incision pain at motion and contractions pain of group S2 and group S3 were lower than those of group S1 at 8, 24, 48 h after surgery (P<0.05). Compared with group S1, the serum level of prolactin in group S2 and S3 were higher at 24 and 48 h, postoperatively. Compared with group S3, the intestinal exhaust time (39.49±6.01) h and the incidence of nausea and vomiting (26.7%) after surgery in group S1 and S2 were lower (P<0.05). Conclusion Ultrasound-guided TAP combined with 0.75 ug/ml sufentanil for PCIA after cesarean section has good analgesic effect, little effect on the secretion of prolactin, but it can promote the recovery of gastrointestinal tract and reduce the incidence of adverse reaction, which is a positive way to promote the application of ERAS in perioperative period of cesarean section