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腹横肌平面阻滞对全麻剖宫产术后恢复的影响:一项倾向评分匹配回顾性队列研究。

Transversus abdominis plane block improves postoperative recovery following cesarean delivery under general anesthesia: A propensity score matched retrospective cohort study.

机构信息

Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.

Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.

出版信息

Int J Gynaecol Obstet. 2024 Feb;164(2):641-649. doi: 10.1002/ijgo.15011. Epub 2023 Jul 26.

Abstract

OBJECTIVE

To evaluate the effects of transversus abdominis plane (TAP) block on postoperative recovery 24 h after cesarean delivery under general anesthesia.

METHODS

A propensity-score-matched, retrospective cohort study was used. A total of 173 pregnancies resulting in elective cesarean delivery under general anesthesia between March 2021 and March 2022 were analyzed retrospectively. Patients receiving TAP block were compared with those receiving only intravenous analgesia. The Quality of Recovery 15 (QoR-15) score, assessed 24 h postoperatively using a 15-item questionnaire, was the primary outcome. Secondary outcomes included time to first ambulation, time to first flatus postoperatively, ability to tolerate ambulation, visual analog scale (VAS) score, hospitalization cost, and postoperative nausea and/or vomiting.

RESULTS

The total QoR-15 score 24 h postoperatively in the TAP group was significantly higher than in the Control group (P < 0.001). Patients in the TAP group had higher Bruggemann comfort scale scores (P < 0.001), could better tolerate early postoperative ambulation (P < 0.001), and had shorter time to first ambulation (P < 0.001) and flatus (P < 0.001). Correlation analysis demonstrated an inverse relationship between the cumulative VAS pain scores, time to first postoperative ambulation, time to first flatus, and total QoR-15 score 24 h postoperatively.

CONCLUSIONS

Following cesarean delivery under general anesthesia, TAP block combined with intravenous analgesia can improve postoperative recovery and shorten the time to postoperative ambulation and recovery of intestinal function.

摘要

目的

评价腹横肌平面(TAP)阻滞对全麻剖宫产术后 24 小时的术后恢复的影响。

方法

采用倾向评分匹配的回顾性队列研究。回顾性分析 2021 年 3 月至 2022 年 3 月期间,173 例择期全麻剖宫产患者。将接受 TAP 阻滞的患者与仅接受静脉镇痛的患者进行比较。术后 24 小时采用 15 项问卷评估的恢复质量 15 分(QoR-15)评分是主要结局。次要结局包括首次下床活动时间、术后首次排气时间、下床活动能力、视觉模拟评分(VAS)评分、住院费用和术后恶心和/或呕吐。

结果

TAP 组术后 24 小时总 QoR-15 评分显著高于对照组(P<0.001)。TAP 组患者的 Bruggemann 舒适度评分较高(P<0.001),更早耐受术后早期活动(P<0.001),首次下床活动时间(P<0.001)和首次排气时间(P<0.001)更短。相关性分析表明,累积 VAS 疼痛评分、术后首次下床活动时间、首次排气时间与术后 24 小时总 QoR-15 评分呈负相关。

结论

全麻剖宫产术后 TAP 阻滞联合静脉镇痛可改善术后恢复,缩短术后下床活动和肠道功能恢复时间。

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