椎管内不同给药方式用于妊娠期高血压产妇剖宫产麻醉的观察

Effects of different ways of spinal canal anaesthetic administration on patients with pregnancy-induced hypertension syndrome

目的研究椎管内不同给药方式应用于妊娠期高血压产妇的临床效果。方法 60例符合妊娠期高血压诊断标准的初产妇随机分成3组:以0.75%罗哌卡因行连续硬膜外麻醉为A组,0.75%罗哌卡因行一次性腰麻为B组,0.75%罗哌卡因行腰硬联合麻醉为C组。观察麻醉后胎儿剖出的时间、最高阻滞平面和胎儿Apgar评分情况及麻醉前后的血压及并发症的情况。结果与A组相比,B、C 2组胎儿娩出时间,麻醉后起效时间差异有统计学意义(P<0.01);与B组相比,A,C 2组麻醉平面差异有统计学意义(P<0.05);与C组相比,A、B 2组麻醉后低血压发生率差异有统计学意义(P<0.05).而A、B、C 3组的Apgar评分差异无统计学意义(P>0.05)。结论 0.75%罗哌卡因行腰硬联合麻醉对妊娠期高血压产妇术中镇痛效果确切,能够迅速剖出胎儿,对胎儿影响小,Apgar评分高,麻醉后低血压发生少,麻醉相关并发症少,适合临床应用。

Objective To study the clinical effects of different ways of spinal canal anaesthetic administration on patients with pregnancy-induced hypertension syndrome. Methods A total of 60 cases meeting the diagnostic criteria forgestational hypertension were randomly divided into three groups：Group A was filled of 0.75%ropivacaine with continuous epidural anesthesia,Group B was given 0.75%ropivacaine with spinal anesthesia singly,and Group C was given 0.75%ropivacaine combined with spinal epidural anesthesia.The birth of the fetus,the maximum block level; changes in blood pressure,neonatal Apgar scores,and other complications were detected and recorded. Results Compared with Group A,there were significant differences in term of both the time of the fetus,birth and onset of anesthesia in Group B and Group C（P0.01）.There were significant differences in Group A and Group C in the block level,compared with Group B（P0.05）.The rates of hypotension incidence after anesthesia in both Group A and Group B were higher than that in Group C,but there were no obvious differences among the three groups in the Apgar scores（P0.05）. Conclusions The analgesic effect of 0.75%ropivacaine combined with spinal epidural anesthesia on pregnancy-induced hypertension syndrome caesarean section is excellent.It is suitable for the clinical application, providing quickly cross section of the fetus,little effect on the fetus,high Apgar scores,less incidence of hypotension and other complications after anesthesia.