连续腰麻用于重度妊高症剖宫产手术的临床观察

Study on continuous spinal anesthesia for caesarean section in patients with pregnancy-induced hypertension

目的探讨连续腰麻用于重度妊高症剖宫产手术的效果和安全性。方法选择80例重度妊高症拟行剖宫产的产妇随机分为两组,腰硬联合麻醉组(CSEA)和连续腰麻组(CSA),每组40例。CSA组首剂给予0.5%罗哌卡因重比重液7.5 mg,5 min后测试感觉阻滞平面,若低于T8,追加罗哌卡因每次2.5 mg,CSEA组给予0.5%罗哌卡因重比重液10 mg。观察罗哌卡因用量、Bromage运动阻滞分级、感觉阻滞平面、麻醉后血流动力学变化、麻黄碱用量、并发症等指标。结果①两组的感觉阻滞平面和运动阻滞分级比较差异无统计学意义(P>0.05);②两组的血流动力学波动无统计学差异(P>0.05),但CSEA组低血压发生率明显高于CSA组(P<0.01)。③CSEA组罗哌卡因用量和静脉使用麻黄碱的剂量明显高于CSA组,两组比较有统计学差异(P<0.01)。④两组均无严重并发症出现。结论连续腰麻用于重度妊高症剖宫产手术的麻醉是安全有效的。

Objective To explore the effect and safety of continuous spinal anesthesia （CSA） for caesarean section （CS） in patients with pregnancy - induced hypertension （PIH）. Methods Eighty patients with serious PIH undergoing CS were randomly divided into 2 groups： 40 pa- tients received combined spinal and epidural anesthesia （CSEA） in CSEA group （n = 40） and 40 patients received continuous spinal anesthesia （CSA） in CSA group. Patients in CSA group received a first dose of 0.5% ropivacaine 7.5mg, then an extra dose of 2.5mg once the anesthesia level lower than T8. Patients in CSEA group received O. 5% ropivacaine 10 mg. The dosage of ropivacaine, Bromage scoring, level of sensory block, changes of hemodynamios, dosage of ephedrine, and complications were recorded and compared. Results There was no significant differ- ence in Bromage scores and level of sensory block between these two groups （ P 〉 0.05 ）. Hypotension in CSEA group was more significant than that of CSA group （ P 〈0.01 ）. The dosages of ropivacaine and ephedrine used in CSEA group were more higher than those of CSA group （ P 〈 0.01 ）. No complication happened either in CSEA group or in CSA group. Conclusion Continuous spinal anesthesia is an effective and safe method for caesarean section in patients with PIH.