Clinical Application Of Ultrasound-guided Abdomen Nerve Block Combined With Remifentanil Infusion In Cesarean Section In Patients With Thrombocytopenia

ObjectiveWith the introduction of the"two-child policy",the number of pregnant women in our country is increasing day by day and the number of pregnant women with thrombocytopenia is large.The type of parturients usually terminates pregnancy by cesarean section,which usually takes intraspinal anesthesia.As a contraindication of intraspinal anesthesia,the parturients who have thrombocytopenia usually take general anesthesia rather than intraspinal anesthesia during cesarean section in clinic.Because general anesthesia can inhibit the respiration and circulatory system of newborn,it has aroused wide attention of clinical anesthesiologists.Thus,the subject of ultrasound-guided quadratus lumborum block-rectus abdominis sheath nerve block combined with remifentanil infusion was used in cesarean section of pregnant women with thrombocytopenia.The clinical effect of this anesthetic method and its effect on newborns were observed.Methods Sixty full-term pregnant women,ASA?or?,aged 20³2 yrs,heighing155¹70 cm,weighing 50⁸0 kg,gestational week 38⁴0 weeks,were selected for cesarean section in our hospital.The standard of selected in this study includes full-term pregnant women,first cesarean section,thrombocytopenia and platelet count less than 7×10⁹/L.And the samples of pregnant women who have serious diseases such as pregnancy-induced hypertension and diabetes mellitus,as well as patients with premature delivery,fetal distress and infection at puncture sites were excluded.It is also been excluded that patients who are allergic to ropivacaine and opioid drugs,the previous history of abdominal surgery,severe abnormalities in major organ functions as well as taking antidepressants or psychotropic drugs.The pregnant women were randomly divided into two groups by random number table method:the group of quadratus lumborum block-rectus sheath block combined with remifentanil?group QS?and the group of general anesthesia?group GA?,30 cases in each group.Patient-controlled intravenous analgesia?PCIA?was performed in both groups after operation.The operative time?indirect reflection of intraoperative muscle relaxation?was recorded and compared between the two groups.Hemodynamic changes were observed before anesthesia?T₁?,immediately after skin incision?T₂?and fetal delivery?T₃?in two groups.When the fetus was delivered,the umbilical cord was clamped with double clamp,and the umbilical artery blood gas analysis was performed to record the oxygen partial pressure?PO₂?.The Apgar scores of 1 min,5 min and 10 min after birth were recorded.The analgesic effect of parturients were observed after operation.The consumption of sufentanil and VAS scores of rest and exercise were recorded at 4 h,8 h,12 h,24 h and 48 h after operation.The postoperative incidence adverse reactions and analgesia satisfaction were recorded.Results Compared with group GA,the operation time of group QS was significantly longer than that of group QS?P<0.05?,but the fetuses were taken out within 6 min in both groups.The score of postnatal 1 min Apgar in group QS was significantly higher than that in group GA?P<0.05?.The Apgar score of 1 min after birth in group QS was9-10 points.In group GA,twelve newborns developed respiratory depression at birth,seven of them had Apgar score of 1 min after birth,and five of them had Apgar score of6 points.After the mask inhaled oxygen,there was some relief.There was no significant difference in blood pressure and heart rate between the two groups at T₁ and T₂,but at T₃,compared with GA group,the blood pressure and heart rate of group QS were higher than those of group GA?P<0.05?,while the blood pressure and heart rate of group QS were higher than those of group GA at T₃ and T₂.However,the pregnant women did not show obvious symptoms of discomfort.Compared with group GA,the consumption of sufentanil and the scores of resting and exercise VAS in group QS decreased significantly within 48 hours after operation?P<0.05?.Compared with GA group,the incidence of postoperative side effects such as nausea,vomiting and vertigo in group QS was significantly lower?P<0.05?.The satisfaction degree of analgesia in group QS was significantly higher than that in group GA?P<0.05?.In addition,no side effects such as puncture infection and hematoma associated with abdominal nerve block were found in group QS.ConclusionUltrasound-guided QLB-RSB combined with remifentanil infusion was used in cesarean section of the women who have thrombocytopenia.It can not only effectively relieve the abdominal pain,reduce the consumption of opioid drugs but also improve the score index of analgesia,and provide a good and effective analgesic effect for the puerperant.The satisfaction degree of parturients is greatly improved,and the influence on neonatal respiration and circulation is relatively small.In summary,there is a widely safe range of use in clinical application.