不同体位穿刺腰硬联合麻醉在肥胖产妇剖宫产手术中的比较

Comparison of puncture in different positions with combined spinal and epidural anesthesia in obese parturients for cesarean section

目的观察不同体位穿刺腰硬联合麻醉(CSEA)在肥胖产妇剖宫产手术中对产妇麻醉效果、麻醉操作和血流动力学的影响。方法选择剖宫产手术肥胖产妇80例[体重指数(BMI)≥30],ASA分级Ⅰ或Ⅱ级,随机均分为两组,A组:侧卧位腰硬联合麻醉,腰麻液为0.5%盐酸罗哌卡因2.4ml。B组:坐位腰硬联合麻醉,腰麻液同A组。记录两组一次穿刺成功率、麻醉平面、麻醉效果、血流动力学变化及不良反应发生情况(包括术中仰卧位低血压综合征,脊麻后头痛以及术后脊神经刺激)。结果 B组麻醉效果与A组相比差异无统计学意义,但一次穿刺成功率高于A组(P<0.05),血流动力学变化差异有统计学意义(P<0.05)。仰卧位低血压综合征的发生率低于A组(P<0.05)。结论两种体位腰硬联合麻醉在肥胖产妇剖宫产手术麻醉中具有相同的麻醉效果,但坐位腰硬联合麻醉比侧卧位更易于穿刺操作,血流动力学更稳定。

Objective To observe the influence of combined spinal and epidural anesthesia（CSEA） of different positions on the anesthesia effect, anesthesia operation and hemodynamic index during cesarean section of obese parturients. Methods Eighty obese parturients [ BMI≥30 ] undergoing cesarean section were randomly divided into two groups, that was group A and B, with 40 cases each. In group A, the parturients were required to undergo lateral decubitus position with 0. 5 % ropivaeaine hydroehloride of 2.4 ml. In group B, the parturients were required to undergo sitting position with the same ropivacaine hydrochloride as group A. The following data was recorded, which were the percentage of one-attempt＇ s successful epidural needle placement, the anesthesia level, the anesthesia effect and the hemodynamic change. All the complications were also observed, such as the supine hypotension syndrome during operation, headache after spinal anesthesia and postoperative spinal nerve stimulation. Results The difference of anesthetic effect between the two groups was insignificant in statistics while group B＇ s rate of one- attempt successful puncture was higher than gruop A （ P 〈 0. 05 ）. The difference of hemodynamic index between them was significant in statistics （ P 〈 0.05 ） with group B＇ s rate of supine hypotension syndrome lower than group A. Conclusion Both body positions have the same anesthtic effect for obese parturients during cesarean section while the puncture operation of sitting positon is easier than lateral decubitus position and the hemodynamic change is also more stable.