改良式腰-硬联合麻醉对剖宫产产妇心血管系统的影响

目的：观察改良式腰-硬联合麻醉对产妇术中心血管系统、术后镇痛及对胎儿的影响。方法选择ASAⅠ~Ⅱ级、年龄18~37岁的足月待产需行剖宫产术的孕妇130例，按日期随机分成改良方法组（观察组）和传统方法组（对照组）两组，各65例。观察组首先于T12~L1椎间隙行硬膜外穿刺、置管，再在L2~3椎间隙行蛛网膜下腔穿刺、注药；对照组仅在L2~3椎间隙硬膜外穿刺，成功后利用针内针技术行蛛网膜下腔穿刺、注药，然后再置入硬膜外导管。观察两组麻醉前、麻醉后5min、胎儿娩出即刻及娩出后5min的平均动脉压（MAP）、心率（HR）变化，以及胎儿脐带血气分析。结果两组麻醉前后MAP差异有统计学意义（P〈0.01），HR差异无统计学意义，脐带血气中乳酸两组差异有统计学意义（P〈0.05）、PO2和pH差异无统计学意义，术后镇痛评分差异有统计学意义（P〈0.01）。结论改良式腰-硬联合麻醉用于剖宫产术麻醉效果佳、对心血管系统影响少，有良好的术后镇痛作用，并对胎儿代谢影响少。

Objective To observe the effects of the modified combined spinal-epidural anaesthesia on the cardiovascular system, postoperative pain ,the fetus and the puerperal undergoing uterine-incision delivery. Methods 130 cases of termed predelivery puerperal from age 18 to 37 and of ASAⅠ~Ⅱwho will undergouterine-incision delivery were chosen. They were divided into observation group（ with modified techniques） and traditional group（control） with 65 in each group. In the observation group, an epidural puncture and cather placement was applied in T12~L1, followed by a puncture and drug administration in subarachnoid space in L2~3 , while in control group, only an epidural puncture L2~3 were performed, followed by the puncture,drug administraton and cather placement in subarachnoid space. The MAP, HR and blood gas analysis were observed before anesthesia and 5 min after anesthesia in the two group. Results There were statistical difference in MAP（P〈0.01）and lactic acid in blood gas analysis（P〈0.05） between the two groups while no significant difference in HR）、PO2 and pH, The pain scoring was different（P〈0.01）. Conclusions The effects of the modified combined spinal-epidural anaesthesiapostoperative pain is good and has reduced influence on the cardiovascular system for the puerperal undergoing uterine-incision delivery, the postoperative pain and the influence for the fetus are reduced.