剖宫产中腰麻与硬膜外麻醉的比较

Comparison of spinal anaesthesia and epidural anaesthesia for cesarean section

目的比较腰麻(CS)和硬膜外麻醉(EA)对剖宫产手术的麻醉效果及安全性。方法ASAⅠ～Ⅱ级剖宫产20例,随机分CS组和EA组,每组各10例。CS组用重比重1.5%盐酸利多卡因,EA组用1.5%盐酸利多因。分别入手术室(T0)、切皮(T1)、胎儿娩出(T2)、手术结束(T3)时,多功能监护仪监测产妇平均动脉压(MBP)、心率(HR)等生命体征及脉搏氧饱和度(SpO2),同时评定麻醉效果;记录注射局麻药至胎儿娩出时间(ID)、子宫切开至胎儿娩出时间(UD)及新生儿娩出1min及5min的Apgar评分。结果整个过程产妇MBP、HR、SpO2无明显变化;CS组麻醉起效时间、ID、UD短(P<0.01)、麻醉及肌松效果比EA组好。两组新生儿Apgar评分差异无显著意义(P>0.05)。结论两种麻醉均可抑制产妇应激反应,CS更明显;对新生儿无不良抑制;只要应用得当,两者均安全有效,CS效果更好。

Objective To assess the effect and safety of spinal anaethesia and epidural anaethesia for caesarean section.Methods Twenty patients(ASA grade Ⅰ) were randomly divided into two groups:spinal group(CS,n=10),epidurral group(EA,n=10).2ml of 1.5% hyperbaric hydrochloric lidocaine was given in CS group;13～16ml of 1.5% hydrochloric lidocaine was administrated in EA group.Mean arterial press(MAP),heart rate(HR) and satisfy degree of puls oxygen(SpO2) were measured at coming-in the operation room(T0),immediately after skin incision(T1),at delivery(T2) and the end of surgery(T3).The anaethesic effect,the duration between the induction of spinal or epidual block or and delivery(I-D),the duration between the uterus incision and delivery(U-D) and Apgar score of the neonate at 1min and 5min after birth were recorded.Results In the whole course, marked change didn't happen at maternal MAP,HR,SpO2 in every group.There was no significantly different in Apgar scores of the neonates between the two groups(P>0.05).In CS group,the block is faster in onset,the I-D and U-D was significantly shorter(P<0.01),the anaethesia effect was better.Conclusions Both of the two techniques can inhibit stress response of parturients to cesarean sections,it was greater in CS group than that in EA group.They have no adverse effects to neonates and were safe and efficient when were applied in proper management.CS has better efficacy than EA.