腰麻-硬膜外联合麻醉在急诊剖宫产术中的应用

Application of the Combined Spinal-Epidural Anesthesia(CSEA) on Emergency Treatment of Cesarean Section

目的：探讨腰麻-硬膜外联合麻醉（CSEA）应用于急诊剖宫产术的安全性及临床效果。方法：对60例需急诊剖宫产的产妇随机分组施行腰麻-硬膜外联合麻醉（CSEA）和硬膜外麻（EA）,每组30例,CSEA组用药为0.75%盐酸布比卡因8～12mg＋10%葡萄糖1ml,EA组用药为2%盐酸利多卡因10～15ml（含1/20万盐酸肾上腺素）,两组皆控制麻醉平面达T7水平,监测并记录BP、SPO2、EKG、HR,麻醉起效时间,麻醉阻滞效果,脊神经阻滞上界平面时间,麻醉至胎儿娩出时间（I-D）,新生儿Apgar评分及不良反应。结果：CSEA麻醉起效时间和脊神经阻滞上界平面时间比EA组少（P〈0.01）,CSEA组I-D短于EA组（P〈0.01）,CSEA组麻醉阻滞效果优于EA组,两组新生儿评分及不良反应无明显差异性。结论：CSEA综合腰麻和硬膜外麻的优点,具有诱导快、阻滞完善、对循环呼吸干扰少、母婴安全的优点,用于急诊剖宫产麻醉是安全可行的。

Objective： Investigation has been made on safety and clinical results of the combined spinal - epidural anesthesia （ CSEA ） applying to emergency treatment of cesarean section operations. Method： Randomly divided 60 cases necessary for emergency treatment of cesarean section operation into CSEA and epidural anesthesia （ EA ） groups, where the CSEA group applying 0.75% bupivacaine HCI 8 ～ 12mg ＋ 10% GS and the EA group applying 2% lidocaine HCL 10 ～ 15ml （ 1/200000 adrenailne HCL）, control the anesthetic peak plane of beth groups to T6 level, test and record the BP, SPO2, EKG, HR, anesthetic block effect, initial block time, peak plane time of spinal nerve, time between anesthesia and fetus out （ I - D ）, Apgar score of neonate and adverse effects. Result： The time from initial to peak anesthesia of CSEA group is shorter than EA group （ P 〈0.01） ,I - D of CSEA group is shorter than EA group （ P 〈0.01 ）, then the anesthetic block effect of CSEA group is better than that of EA group; no substantial difference for APgar Score and adverse effects between the two groups. Conclusion： Combined the advantages of SA and EA, CSEA has the advantages of fast initiation, complete block, less interference to circulation and respiratory systems, and safe to mothers and infants. It is safe and feasible for emergent treatment of cesarean section operations.