比较蛛网膜下隙阻滞与硬膜外联合麻醉时不同体位对剖宫产患者血流动力学的影响

Influence of subarachnoid space associated with epidural anesthesia at different posture on the hemodynamics during cesarean section

目的 观察不同体位蛛网膜下隙阻滞与硬膜外联合麻醉（简称腰硬联合麻醉）穿刺时对产妇血流动力学的影响.方法 120例行产科择期手术患者按随机数字表法分为左侧卧位组（LL组）和右侧卧位组（RL组）.两组均取L2～3间隙腰硬联合麻醉穿刺,穿刺成功后注入0.5％罗哌卡因2ml.然后向头端置入硬膜外导管3～4 cm,固定导管后嘱产妇平卧.记录各组麻醉前和麻醉后3,5,10,15 min患者的收缩压（SBP）、舒张压（DBP）、心率及新生儿l,5 min的Apgar评分.结果 RL组麻醉后3,5 min与麻醉前比较血压明显降低,SBP分别为（120.1±11.2）,（106.7±17.2）,（127.3±13.6） mmHg（1 mmHg=0.133 kPa）; DBP分别为（77.5±6.3）,（55.2±21.2）,（80.3±10.5）mmHg;差异均有统计学意义（P＜0.05）.也明显低于LL组,SBP分别为（123.2±12.4）,（110.3±16.3）mmHg; DBP分别为（80.1±9.9）,（63.1±13.2） mmHg;差异均有统计学意义（P＜0.01）;新生儿出生后1,5 min的Apgar评分组间差异无统计学意义.结论 左侧卧位行腰硬联合麻醉可有效降低剖宫产术中低血压的发生率.

Objective To observe the influence of subarachnoid space associated with epidural anesthesia at different posture on the hemodynamics during cesarean section.Methods One hundred and twenty uterine-incision delivery patients were chosen,the patients were separated into the left lateral decubitus group（LL group） and right lateral decubitus group（RL group） with 60 cases each by random digits table method,all the patients were blocked by subarachnoid space associated with epidural anesthesia after puncturation 2 ml 0.5％ ropivacaine was given.Then the head end epidural catheter insertion in 3-4 cm,asked maternal supine after fixed catheter enjoin.Systolic blood pressure （SBP）,diastolic blood pressure （DBP）,heart rate were recorded before anesthesia and at 3,5,10,15 min after anesthesia.Apgar scores of 1 and 5 min were observed as well.Results SBP and DBP at 3,5 min after anesthesia were significantly lower than those before anesthesia in RL group,SBP was （120.1 ± 11.2）,（106.7 ± 17.2）,（127.3 ± 13.6）mmHg （1 mmHg =0.133 kPa） respectively,DBP was （77.5 ± 6.3）,（55.2 ± 21.2）,（80.3 ± 10.5） mmHg,respectively,and there were significant differences （P ＜0.05）.And SBP,DBP in RL group were also significantly lower than those in LL group,SBP was （123.2 ± 12.4）,（110.3 ± 16.3） mmHg,DBP was （80.1 ± 9.9）,（63.1 ± 13.2） mmHg,and there was significant difference （P ＜ 0.05）.There was no significant difference in Apgar scores of 1 and 5 min between two groups.Conclusion The left lateral decubitus position could effectively reduce the incidence of hypotension during caesarean section under subarachnoid space associated with epidural anesthesia.