腰麻与硬膜外麻醉对剖宫产母婴安全及应激反应的影响

Materal-neonatal safety and stress during spinal and epidural anesthesia for cesarean section

目的:研究椎管内麻醉对剖宫产母婴安全和应激反应。方法:选择ASA Ⅰ级剖宫产42例,随机分腰麻组和硬膜外组各21例。腰麻组用重比重0.5%丁哌卡因3ml,硬膜外组用0.75%丁哌卡因12～15ml。两组产妇于入手术室、麻醉后、胎儿娩出、手术结束,新生儿脐静脉抽取血样,检测儿茶酚胺、血糖、乳酸、血气。结果:两组儿茶酚胺麻醉后不同期间均比麻醉前明显降低(P<0.01),两组产妇血糖、乳酸不同期间均无显著性差异,两组新生儿Apgar评分无显著性差异。结论:腰麻与硬膜外麻醉均可抑制产妇手术的应激反应,有利于产妇术后恢复,对新生儿无不良抑制,运用得当可保证母婴安全。

The materal-neonatal safety and materal stress response were evaluated during intratheeal anesthesia. Method: Forty-two parturients(ASA grade 1 )were randomly divided into two groups: spinal group (n=21), epidural group (n=21). 3 ml of 0.5% hyperbaric bupivacaine was given in spinal group; 12-15ml of 0.75 % bupivacaine was administrated in epidural group. Materal arterial samples were drawn before anesthesia,after anesthesia induction, after delivery and at the end of surgery; umbilieal venous samples were taken for measurements of blood catecholamine, sugar and lactate concentrations. Result; Compared with those before intrathecal blockade, plasma levels of catecholamine of two groups were significantly decreased in different periods during anesthesia (P<0.01); levels of materal blood sugar and lactate in both groups remained unchanged during whole procedures (P>0.05); there were not any significant differences between the two groups in neonate Apgar scores. Conclusion:Both of two techniques can inhibit stress response of parturients to cesarean sections and have no adverse effects to neonates when applied in proper management.