腹直肌鞘阻滞用于剖宫产术后镇痛效果观察及对产后抑郁发生的影响

    Analgesic effects of rectus sheath block and its effect on postpartum depression after cesarean section

    • 摘要:
      目的观察腹直肌鞘阻滞在剖宫产术后镇痛效果及对产妇产后抑郁发生的影响。
      方法选取行宫产术产妇60例,ASAⅠ~Ⅲ级,采用随机数字表法,随机分为对照组(N组)和腹直肌鞘阻滞组(R组),各30例。采用腰-硬联合麻醉。手术结束后,R组在超声引导下行双侧腹直肌鞘阻滞,N组不进行腹直肌鞘阻滞。2组产妇术后均接静脉自控镇痛泵。观察术后6 h(T1)、12 h(T2)、24 h(T3)及48 h(T4)产妇切口痛(静息及咳嗽状态)、子宫收缩痛,产后抑郁及不良反应的发生情况。
      结果R组在术后不同时间点静息时及咳嗽时,切口痛NRS评分均低于N组(P < 0.01)。R组产妇子宫收缩痛均低于N组(P < 0.01)。R组产后抑郁发生率及不良反应低于N组(P < 0.05~P < 0.01)。
      结论双侧腹直肌鞘阻滞复合静脉镇痛泵用于剖宫产术后镇痛效果、产妇满意度,优于单纯使用静脉镇痛泵,并且减少术后48 h内产后抑郁的发生。

       

      Abstract:
      ObjectiveTo observe the clinical analgesic effects of rectus sheath block and its effect on postpartum depression after cesarean section.
      MethodsSixty puerperas with ASA level Ⅰ to Ⅲ, treated with cesarean section were randomly divided into the control group(group N) and rectus sheath block group(group R)(30 cases in each group).The combined lumbar and epidural anesthesia in two groups were performed.After the operation, the bilateral rectus sheath block guided by ultrasound in group R was performed, while the rectus sheath block was not performed in group N.Two groups were treated with intravenous controlled analgesia pump after obstetric operation.The incision pain(resting and coughing), uterine contractile pain, postpartum depression and adverse reactions were observed after 6(T1), 12(T2), 24(T3) and 48(T4) of operation.
      ResultsAt different time points after surgery, the NRS scores of incision pain at rest and coughing in group R were significantly lower those in group N(P < 0.01).The NRS score of uterine contractile pain in group R was lower than that in group N(P < 0.01).The incidence rates of adverse reactions and postpartum depression in group R were lower than those in group N(P < 0.05 to P < 0.01).
      ConclusionsThe analgesia effects and maternal satisfaction after cesarean section in bilateral rectus sheath block combined with intravenous analgesia pump is better than that in simple intravenous analgesia pump, and which can reduce the incidence rate of postpartum depression within 48 h after surgery.

       

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