腰麻硬膜外联合麻醉与硬膜外麻醉对剖宫产病人血流动力学影响的对比研究

Comparative study of effects of combined spinal-epidural anesthesia and epidural anesthesia on haemodynamics in the puerpera with cesarean delivery

目的:研究及完善剖宫产的麻醉管理,为临床提供借鉴,确保母婴安全。方法:将80例需剖宫产产妇随机分为腰麻硬膜外联合麻醉(combined spinal epidural anesthesia,CSEA)组和硬膜外麻醉(epiduralanaesthesia,EA)组,监测2组剖宫产患者血流动力学变化,并比较麻醉效果、新生儿Apgar评分、并发症及不良反应。结果:CSEA组产妇心率(heart rate,HR)在T4(胎儿娩出10 min)、T5(手术结束)高于EA组(P=0.023、0.022);CSEA组产妇收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP)在T3(胎儿娩出)高于EA组(P=0.000、0.000);CSEA组产妇平均动脉压(mean arterial pressure,MAP)在T2(麻醉平面满意-消毒前)、T5(手术结束)高于EA组(P=0.000、0.003);2组产妇不同时刻心输出量(cardiac output,CO)、每博输出量(stroke volume,SV)、体循环阻力(systemic circulation resistance,SVR)及胸部液体含量(thoracic fluid content,TFC)比较,差异无统计学意义(P>0.05);2组产妇不同时刻HR、SBP、DBP、MAP、CO、SV及SVR组内比较差异均具有统计意义(均有P<0.05);CSEA组麻醉效果优于EA组,差异有统计学意义(P=0.000);2组之间麻醉并发症、不良反应及新生儿出生后Apgar评分差异无统计学意义(P>0.05)。结论:硬膜外麻醉和腰麻硬膜外联合麻醉均为适合剖宫产手术的麻醉方式,但腰麻硬膜外联合麻醉:起效更快、麻醉效果更完善、对产妇血流动力学影响小,更为推荐。

Objective ：To research and improve the anesthesia management of cesarean delivery and to provide references for clinical to ensure the maternal and child safety. Methods：Eighty puerpera with cesarean delivery were randomly assigned to receive com- bined spinal-epidural anesthesia（CSEA group） or epidural anesthesia （EA group） with 40 cases in each group. Homodynamic changes, anesthetic effect, neonatal Apgar score, complications and adverse reactions were measured in the two groups. Results：Heart rate（HR） of puerpera was higher in CSEA group than in EA group at T4（10 rain after child birth）and Ts（operation finish）（P= 0.023,0.022）. Systolic blood pressure（SBP） and diastolic blood pressure （DBP） were higher in CSEA group than in EA group at T3 （child birth）（P=-0.000,0.000）. Mean arterial pressure（MAP） was higher in CSEA group than in EA group at TE（satisfied anesthesia- before disinfection） and T5 （operation finish） （ P=0.000,0.003 ）. There was no differences in cardiac output （C O）, stroke volume （SV）, systemic vascular resistance （SVR） and thoracic fluid content （TFC） between two groups at different time points （all P〉0.05）.There were differences in HR,SBP,DBP,MAP,CO,SV and SVR within each group at different time points（P〈0.05）. Anesthetic effect of CSEA group was better than that of EA group （P=0.000）. There were differences in neonatal Apgar score, complications and adverse reactions between two groups （P〉0.05）. Conclusion：EA and CSEA are both suitable anesthesia for the puerpera with cesarean de- livery. However, CSEA is more recommended for its faster onset,better anesthetic effect and little effect on maternal hemodynamics.