超声引导下外侧入路腰方肌阻滞对剖宫产产后镇痛效果和泌乳的影响

目的探讨超声引导下外侧入路腰方肌阻滞对剖宫产产后镇痛效果和泌乳的影响。方法选取剖宫产孕妇120例,随机分为观察组和对照组,观察组术后给予超声引导外侧入路腰方肌阻滞+静脉自控镇痛;对照组术后仅行静脉自控镇痛。观察两组术后6 h、12 h、24 h和48 h静息、运动视觉模拟评分法(VAS)评分和Ramsay镇静评分,以及血清多巴胺、去甲肾上腺素、肾上腺素和泌乳素的水平变化,并记录各组术后镇痛按压次数、追加镇痛药物量和初乳时间。结果观察组产妇在术后6 h、12 h、24 h和48 h时间点静息和运动VAS评分均低于对照组(t分别=20.82、22.19、19.25、8.91、17.44、17.63、15.13、13.53,P均<0.05)。观察组产妇在术后6 h、12 h、24 h和48 h时间点Ramsay镇静评分高于对照组(t分别=20.10、16.40、27.97、11.07,P均<0.05)。观察组产妇术后自控镇痛按压次数和追加镇痛药物量均低于对照组(t分别=54.51、31.85,P均<0.05)。观察组产妇术后6 h、12 h、24 h和48 h时间点血清多巴胺、去甲肾上腺素和肾上腺素均低于对照组(t分别=16.95、24.48、21.03、7.65、5.41、4.47、5.17、5.32、11.52、22.85、25.26、24.06,P均<0.05),观察组产妇术后6 h、12 h、24 h和48 h血清泌乳素水平高于对照组(t分别=14.22、10.53、8.65、10.08,P均<0.05)。观察组产妇初乳时间早于对照组产妇(t=25.65,P<0.05)。结论超声引导下外侧入路腰方肌阻滞可以有效减轻剖宫产术后疼痛,促进泌乳素分泌,缩短初乳时间。

Effect of ultrasound-guided lateral approach quadratus lumborum block on postoperative analgesia and lactation after cesarean section

Objective To observe ultrasound-guided lateral approach quadratus lumborum block on postoperative analgesia and lactation after cesarean section.Methods Totally 120 parturients underwent cesarean section were randomly divided into the control group and observation group.Parturients in the observation group were given ultrasound-guided lateral approach quadratus lumborum block and patient controlled intravenous analgesia(PCIA).The control group was given PCIA only.The visual analogue scale(VAS)and Ramsay sedation scale at 6h,12h,24h,and 48h after the operation were measured.The serum dopamine,norepinephrine,epinephrine,and prolactin were recorded.The press times of analgesia pump,additional analgesic dosage,the colostrum time were observed.Results The VAS scores during rest and exercise in the observation group were lower than those in the control group at 6h,12h,24h,and 48h after surgery(t=20.82,22.19,19.25,8.91,17.44,17.63,15.13,13.53,P<0.05).The Ramsay sedation scale in the observation group were higher than those in the control group at 6h,12h,24h,and 48h after surgery(t=20.10,16.40,27.97,11.07,P<0.05).The PCIA press times,additional analgesic dosage of observation group were lower than those of control group(t=54.51,31.85,P<0.05).The dopamine,norepinephrine and epinephrine of observation group were lower than those of control group at 6h,12h,24h,and 48h after surgery(t=16.95,24.48,21.03,7.65,5.41,4.47,5.17,5.32,11.52,22.85,25.26,24.06,P<0.05).The prolactin of observation group were higher than that of control group at 6h,12h,24h,and 48 h after surgery(t=14.22,10.53,8.65,10.08,P<0.05).The colostrum time of the observation group was earlier than that of the control group(t=25.65,P<0.05).Conclusion Ultrasound guided lateral approach quadratus lumborum block can effectively alleviate the pain after cesarean section,promote prolactin secretion and shorten colostrum time.