中文摘要：

目的 评价超声引导下腹横肌平面（transversus abdominis plane, TAP）阻滞用于剖宫产患者超前镇痛的效果。 方法 采用前瞻性、随机对照研究设计。择期行剖宫产患者90例，年龄20~39 岁，体重50~80 kg，ASA分级Ⅰ、Ⅱ级，采用随机数字表法分为3组（每组30例）：对照组（Ⅰ组）、术前TAP阻滞组（Ⅱ组）、术后TAP阻滞组（Ⅲ组）。Ⅰ组不实施TAP阻滞，Ⅱ组和Ⅲ组分别于麻醉诱导前即刻和手术结束时即刻在超声引导下行双侧TAP阻滞。记录术后2、4、12、24 h和48 h 时点3组产妇静息状态下的VAS评分，术后24 h内舒芬太尼累积消耗量、镇痛补救率、镇痛泵按压次数，术后24 h内副作用发生情况。 结果 Ⅱ组患者术后2、4 h和12 h VAS评分［（2.3±0.4）、（2.4±0.4）、（2.2±0.4） 分］与Ⅲ组［（3.2±0.8）、（3.4±0.3）、（3.1±0.5） 分］比较，明显降低（P〈0.05）；Ⅱ组患者术后24 h内舒芬太尼累积消耗量、镇痛补救率及镇痛泵按压次数［（40±5） μg、10%、（5.8±1.4） 次］与Ⅲ组［（53±7） μg、20%、（10.3±2.6） 次］比较，明显降低（P〈0.05）；Ⅱ组患者术后24 h内恶心呕吐发生率与Ⅲ组比较，明显降低（P〈0.05）。 结论 术前超声引导下TAP阻滞对剖宫产患者具有良好的超前镇痛效应，且安全性较高。

英文摘要：

Objective To evaluate the efficacy of ultrasound-guided transverses abdominis plane（TAP） block for preemptive analgesia in patients undergoing caesarean section. Methods Ninety ASA physical status Ⅰ,Ⅱ patients, aged 20-39 y, weighed 50-80 kg, scheduled for cesarean section, were randomly divided into 3 groups（n=30） using a random number table： control group（group Ⅰ）, preoperative TAP block group（group Ⅱ） and postoperative TAP block group（group Ⅲ）. Bilateral transverses abdominis plane block was performed under the guidance of ultrasound immediately before induction of anesthesia and at the end of surgery in Ⅱ and Ⅲ groups, respectively. The VAS in each at 2, 4, 12, 24, 48 h after surgery with rest, the cumulative consumption of sufentanil within 24 h, the rate of rescue analgesia and times of pressing patient-controlled intravenous analgesia, the adverse reactions occurred after surgery were detected. Results The VAS scores of the patients in group Ⅱ at 2, 4, 12 h after surgery[（2.3±0.4）, （2.4±0.4）, （2.2±0.4）] were significantly lower when compared with group Ⅲ[（3.2±0.8）, （3.4±0.3）, （3.1±0.5）]（P〈0.05）. The cumulative consumption of sufentanil within 24 h, the rate of rescue analgesia and times of pressing patient-controlled intravenous analgesia of group Ⅱ[（40±5） μg, 10%, （5.8±1.4）] were significantly decreased when compared with group Ⅲ[（53±7） μg, 20%, （10.3±2.6）]（P〈0.05）. The rate of nausea and vomiting in group Ⅱ within 24 h was significantly reduced when compared with group Ⅲ（P〈0.05）. Conclusions Preoperative transverses abdominis plane block can provide good preemptive analgesia in the patients undergoing cesarean section.