论文部分内容阅读
目的:观察全身麻醉复合超声引导下腹横肌平面阻滞在剖宫产手术中的应用效果。方法:抽取2017年6月至2019年8月在河南省人民医院无法实施椎管内麻醉需行全身麻醉剖宫产孕妇60例，术前无早产及胎儿窘迫症状，且均为初次行剖宫产手术者。60例产妇均为单胎、足月(孕38～41周)妊娠，美国麻醉师协会(ASA)分级Ⅰ～Ⅱ级。依据麻醉方式分为全身麻醉复合腹横肌平面阻滞组(N组)和全身麻醉组(G组)，每组30例。两组术后均行患者自控静脉镇痛。比较两组产妇麻醉前、切皮即刻及胎儿剖出时的血流动力学变化和术中阿片类药物瑞芬太尼的用量；比较两组胎儿剖出后的Apgar评分。结果:与N组比较，切皮即刻、胎儿剖出时G组产妇血压升高，心率加快(n P<0.05); N组需追加瑞芬太尼次数少于G组(n P<0.05)。胎儿剖出后1 min，N组新生儿Apgar评分为(9.13±0.68)分，高于G组新生儿的(7.83±0.59)分，n P<0.05。n 结论:超声引导下腹横肌平面阻滞复合全身麻醉应用于剖宫产手术，可减少胎儿娩出前阿片类药物及吸入麻醉药物的用量，产妇血流动力学更平稳，对新生儿影响较小。“,”Objective:To observe the effect of general anesthesia combined with ultrasound-guided transversus abdominis plane block in cesarean section.Methods:Sixty pregnant women undergoing cesarean section under general anesthesia who were unable to implement spinal anesthesia in Henan Provincial People’s Hospital were selected. No preterm labor or fetal distress symptoms occurred before the operation, and all the patients underwent cesarean section for the first time. All of the 60 cases were singleton and full-term (38-41 weeks) pregnancies of the American Society of Anesthesiologists (ASA) grade Ⅰ-Ⅱ. According to the way of anesthesia, patients were divided into general anesthesia combined with transverse abdominis plane block group (group N) and general anesthesia group (group G), with 30 cases in each group. Patient-controlled intravenous analgesia was performed in both groups. The hemodynamic changes and intraoperative opioid (remifentanil) dosage were compared between the two groups before anesthesia, immediately after skin incision, and during fetal section. The Apgar scores of the two groups were compared.Results:Compared with group N, the blood pressure and the heart rate of group G increased immediately after skin incision, and at the time of fetal dissection (n P<0.05). The frequency of remifentanil in group N was less than that in group G (n P<0.05). One min after delivery, Apgar score of group N (9.13±0.68) was higher than that of group G (7.83±0.59),n P<0.05.n Conclusions:Ultrasound-guided transversus abdominis plane block combined with general anesthesia in cesarean section can reduce the dosages of opioids and inhaled anesthetics before delivery, so that the hemodynamics of pregnant women is more stable, and the impact on newborns is small.