不同麻醉方式对重度子痫前期患者剖宫产母婴的影响

Effects of different anesthetic methods on mother and infant in severe preeclampsia patients undergoing cesarean section

目的探讨重度子痫前期患者行子宫下段剖宫产术时不同麻醉方式对母婴的影响。方法选择40例重度子痫前期患者,随机分为两组:腰硬联合麻醉组(CSEA组,n=20)和全身麻醉组(GA组,n=20)。分别记录患者入室时(T0)、手术开始时(T1)、胎儿娩出即刻(T2)患者的平均动脉压;术中麻黄碱使用总量;胎儿娩出后1 min、5 min的Apgar评分。结果与入室时(T0)比较,全身麻醉组手术开始时(T1)平均动脉压明显降低,腰硬联合麻醉组手术开始时(T1)及胎儿娩出即刻(T2)平均动脉压明显降低(P<0.05);与全身麻醉组比较,腰硬联合组的术中麻黄碱使用量及胎儿娩出后1 min的Apgar评分明显增高(P<0.05),5 min的Apgar评分无显著差异(P>0.05)。结论全身麻醉用于重度子痫前期患者的剖宫产手术,血流动力学较平稳,胎儿娩出后1 min的Apgar评分较低;腰硬联合麻醉用于重度子痫前期患者的剖宫产手术,血流动力学波动明显,胎儿娩出后1 min的Apgar评分较高。两种麻醉方式下,胎儿娩出后5 min的Apgar评分均正常。

Objective To explore the effect of different anesthetic methods on mother and infant in severe preeclampsia patients undergoing cesarean section. Methods Forty severe preeclampsia patients were randomly divided into 2 groups ： combined spinal-epidural anesthesia group（ CSEA, n = 20） and general anesthesia group（ GA, n = 20）. The mean arterial pressure（MAP） was recorded when the patients entered the operating room（ T0 ）, at the beginning of operation（ T1 ）, and after delivery（ T2 ）. The usage of ephedrine and the Apgar score at 1 min and 5 min after delivery were all recorded. Results Compared with T0,the MAP was significantly reduced at T1 in GA group, at T1 and T2 in CSEA group （ P 〈 0.05 ）. Compared with GA group, the usage of ephedrine and Apgar score at 1 min increased in CSEA group （ P 〈 0.05 ）, but there was no significant difference at 5 min Apgar score （ P 〉 0. 05 ）. Conclusion Severe preeclampsia patients undergoing GA for cesarean delivery have no significant fluctuation in heraodynamics, but the Apgar score at 1 min is lower. The patients undergoing CSEA for cesarean delivery have significant short-term fluctuations in hemodynamics, and the Apgar score at 1 min is higher. The Apgar score at 5 min are all normal in the two different anesthetic methods.