小剂量布比卡因腰麻复合硬膜外麻醉在重度子痫前期产妇剖宫产术中的应用

Combined Spinal and Epidural Anesthesia with Low Doses of Intrathecal Bupivacaine in Women with Severe Preeclampsia for Cesarean Delivery

目的:比较小剂量布比卡因腰麻复合硬膜外麻醉与单纯硬膜外麻醉在重度子痫前期产妇剖宫产术中的麻醉效果、产妇血流动力学变化及对新生儿的影响。方法:80例重度子痫前期产妇,随机分2组:小剂量布比卡因腰麻复合硬膜外麻醉组(CSEA组)与单纯硬膜外麻醉组(CEA组),每组40例。观察麻醉诱导时间及术中麻醉效果;心率(HR)、平均动脉压(MBP)等血流动力学变化及麻黄素的用量情况;新生儿1、5min Apger评分等。结果:麻醉诱导时间及胎儿娩出时间CSEA组比CEA组明显缩短,术中麻醉效果CSEA组明显优于CEA组,低血压的发生率和严重程度及麻黄素的用量两组相似,新生儿1、5min Apger评分两组无明显区别。结论:小剂量布比卡因腰麻复合硬膜外麻醉用于重度子痫前期产妇剖宫产手术,术中麻醉效果好,产妇血压控制理想,血流动力学稳定,对新生儿影响小,是一种安全有效的麻醉方法。

Objective：To compare the quality of anesthesia for cesarean delivery, hemodynamic changes, and neonatal effects of combined spinal and epidural anesthesia （CSEA） with low intrathecal doses of bupivacaine or epidural anaesthesia（CEA） in patients with severe preeclampsia. Methods： Eighty patients with severe preeclampsia who were scheduled for urgent （not emergency） or elective cesarean delivery consented to receive CSEA with low intratheeal doses of bupivacaine or CEA by random assignment. Anesthesia duration, uterine incision to delivery interval and the quality of anesthesia were investigated. Ephedrine dose and haemodynamic changes such as heart rate（HR） and mean blood pressure（MBP） were recorded. Neonatal outcomes were assessed by 1- and 5-min ~pger scores. Results= Anesthesia duration, uterine incision to delivery interval were shorter, and the quality of anesthesia was higher in CSEA group than that in CEA group. The incidence and severity of hypotension, E- phedrine dose and neonatal 1- and 5-min Apger scores were similar between the two groups. Conclusion： CSEA with low doses of intrathecal bupivacaine were a piece of safe and effective technique suitable for cesarean delivery in severely preeclamptic pa- tients, as the hemodynamic changes were quite modest, with satisfactory neonatal outcome.