HIV感染者剖宫产术的麻醉方法分析

Analysis on types of anesthesia of caesarean section in HIV infected pregnant women

目的:探讨HIV感染者剖宫产术的麻醉方法。方法:HIV感染者足月妊娠62例随机分为A组:单纯硬膜外麻醉组(EA组)和B组:腰硬联合麻醉组(CSEA组),每组31例。观察麻醉显效时间、镇痛肌松效果,麻醉显效前、显效后、胎儿娩出后5min的血压,新生儿娩出后1、5min Apgar评分,麻醉优良率及T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+比值并统计。结果:CSEA组麻醉起效快于EA组,差异有统计学意义(P<0.01),CSEA组显效时间快、麻醉完善、镇痛和肌松效果明显优于EA组。CSEA组的麻醉效果优良率与EA组差异有统计学意义(P<0.05)。CSEA组低血压的发生率高于EA组,但差异无统计学意义(P>0.05)。两组新生儿1、5minApgar评分均大于8分,差异无统计学意义。术前术后外周血测定T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+比值,差异无统计学意义(P>0.05)。结论:两种麻醉方法在HIV感染者剖宫产术的麻醉都可行,但腰麻-硬膜外联合麻醉比单纯硬膜外麻醉具有更大优越性。

Objective： To explore the types of anesthesia of caesarean section in HIV infected pregnant women. Methods： 62 HIV infected pregnant women were divided into group EA （women received epidural anesthesia） and group CSEA （women received combined spinal- epidural anesthesia） on average. Onseting -time of anaesthetic, muscle relaxation effect, blood pressure before and after onseting - time and 5 minutes later after delivery, the Apgar score on the first and fifth minutes after delivery, the effectiveness rate of anaesthetic, the ratios of CD3^＋ , CD4^＋ , CD8^＋ and CD4 ^＋/CD8 ^＋were recorded. Results ： The onseting - time of group CSEA was shorter than that of group EA （ P 〈 0. 01 ） , and the effects of muscle relaxation and analgesia of group CSEA were better than those of group EA. There was significant difference in effectiveness rate of anaesthetic between two groups （ P 〉 0. 05 ） . The incidence of hypopiesis in group CSEA was higher than that in group EA, but no significant difference was found （ P 〉 0. 05 ） . Apgar scores of two groups were above 8, there was no differ- enee. There was no significant different in values of CD3^＋ , CD4 ^＋, CD8 ^＋ , CD4 ^＋/CD8 ^＋ before and after operation. Conclusion ： For HIV -infected parturient women, EA and CSEA are both feasible, but the latter owns more superiority.