腰麻硬膜外联合麻醉在妊娠高血压疾病的临床观察

Clinical observation of combined spinal-epidural anesthesia in parturients with gestational hypertension

目的:探讨妊娠高血压疾病产妇行腰麻硬膜外联合麻醉的临床效应.方法:比较腰椎3～4行腰硬联合麻醉和腰椎2～3行连续硬膜外麻醉在麻醉平面、药量、起效时间、失败率、下肢运动阻滞及镇痛肌松等方面的效果.结果:腰硬联合麻醉在达到最高平面时间、起效时间均显著短于硬膜外麻醉(P＜0.05);局麻药用量腰硬联合麻醉也少于硬膜外麻醉(P＜0.05);而麻醉失败率方面腰硬联合麻醉小于硬膜外麻醉(P＜0.05);镇痛肌松等方面,腰硬联合麻醉好于硬膜外麻醉,呼吸、循环、新生儿Apgar评分等方面无显著性差异(P＞0.05).结论:无并发症及合并症的妊娠高血压疾病的产妇需急症剖宫产手术时,应立即在腰椎3～4行腰硬联合麻醉.

Objective： To research the clinical effect of combined spinal - epidural anesthesia on parturients with gestational hypertension. Methods： To compare combined spinal- epidural anesthesia at L3-4 with continuous epidural anesthesia at L2-3 in the aspects of the anesthesia plane, dosage, time of producing effect, incidence of failure, blockage of lower limb motion , analgesia and muscle relaxation. Results： The time of reaching the highest plane and producing effect in combined spinal - epidural anesthesia was obviously shorter than that in epidural anesthesia （ P 〈 0. 05）. The dosage of local anesthetic and incidence of failure in combined spinal - epidural anesthesia was less than those in epidural anesthesia （P 〈 0. 05）. The analgesia and muscle relaxation in combined spinal - epidural anesthesia were better than those in epidural anesthesia. There was no significant difference in the aspects of respiration, circulation and Apgar score of neonate in these two anesthesia methods （P 〉0. 05）. Conclusion： Combined spinal - epidural anesthesia at L3-4 should be adopted immediately when parturients suffered from gestational hypertension without complications should accept emergency cesarean sections.