坐位行腰硬联合阻滞在剖宫产手术中的观察

Observation on combined spinal and epidural anesthesia performed in sitting position for caesarean section

目的:观察不同体位行腰硬联合阻滞在剖宫产手术中的可行性和安全性。方法:40例剖宫产手术的足月单胎产妇,经L2～3行脊麻—硬膜外穿刺,随机分为A组(坐位穿刺组),B组(左侧卧位穿刺组),观察穿刺时脑脊液流出情况,向蛛网膜下腔注入0.75%布比卡因1.4ml,连续观察记录产妇的SBP、HR和SPO2,记录麻醉起效时间,阻滞最高平面和术中恶心、呕吐的发生率,记录新生儿Apgar评分。结果:两组麻醉起效时间、阻滞最高平面、HR及SPO2无明显差异。SBP较术前均有不同程度下降,下降幅度两组无统计学差异,两组恶心呕吐发生率及新生儿Apgar评分均无明显差异。结论:坐位与侧卧位行脊液与硬膜外联合阻滞均适用于剖宫手术的麻醉。

objective To study the possibility and safety of combined spinal and epidural anesthesia performed in sitting position for caesarean section.Methods 40 primiparas who were punctured at lumbar 2-3 were randomly divided into group A（puncture in sitting position） and group B（puncture in the left lateral）.The flow of CSF after CSE puncture,injected 0.75% bupivacaine 1.4ml into subarachnoid space were observed.The primiparas＇s SBP,HR and SPO2 were recorded.The onset time,the highest nerve block mean level and nausea and vomiting during operation were recorded.Apgar scores were evaluated.Results The onset time,the highest nerve block mean level,HR and SPO2 were not significantly different between the two groups.SBP decreased compared with preoperative states of the primiparas,the lower degree of SBP in two groups was of no significant difference.No significant difference were found in two groups of Apgar,scores,nausea and vomiting.Conclusion Spinal combined epidural anesthesia performed in sitting or lateral position can be used safely and effectively for caesarean section.