腰硬联合麻醉在剖宫产手术中的临床应用体会

Clinical application experience of combined spinal epidural anesthesia in cesarean section operation

目的探讨腰硬联合麻醉用于剖宫产手术中的安全性及临床效果。方法 120例ASA I或Ⅱ级子宫下段剖宫产患者,随机分为两组,I组腰硬联合组（CSEA）60例,2%利多卡因15～20 ml;Ⅱ组硬膜外组（EA）60例,腰麻药为0.3%布比卡因2～3 ml,对比两组患者麻醉阻滞起效时间、阻滞效果以及新生儿Apgar评分和麻醉的并发症。结果腰硬联合组最高阻滞平面及达到时间比硬膜外组短,从麻醉开始到胎儿娩出时间短,麻醉效果明显优于EA组,差异有统计学意义（P〈0.05）,两组患者新生儿Apgar评分及术后并发症差异无统计学意义（P〉0.05）。结论腰硬联合麻醉综合了脊麻和硬膜外阻滞麻醉的优点,同时需要做好围手术期准备以及术中患者生命体征的监测和麻醉处理,腰硬联合麻醉是可行、平稳、安全的。

Objective To investigate safety and clinical effect of combined spinal epidural anesthesia for cesarean section operation. Methods 120 cases of ASA I or II cesarean section patients, randomly divided into two groups, group I combined spinal epidural group（CSEA） in 60 cases, 2% lidocaine 15～20 ml; group II in epidural anesthesia group（EA） 60 cases, spinal anesthesia of 0.3% butacaine 2～3 ml, compared to 2 anesthesia block onset time, anesthesia effect and neonatal Apgar score and complications of anesthesia. Results Spinal epidural group was the highest block plane and the reaching time than epidural group of short, from the start of anesthesia to the fetus delivery time is short, the anesthesia effect was better than that in EA group, there was significant difference（P〈0.05）, no significant difference between two groups of patients with neonatal Apgar score and postoperative complications（P〉0.05）. Conclusion CSEA anesthesia combination of spinal anesthesia and epidural anesthesia has advantages, also need to surround operation period of preparation and monitoring of vital signs during surgery and anesthesia, combined spinal epidural anesthesia is feasible, stable, safe.