蛛网膜下隙与硬膜外联合阻滞对妊高征剖宫产患者血液流变学的影响

The impact of ESCA on hemorheology in PIHS cesarean patients

目的研究蛛网膜下隙与硬膜外联合阻滞(CSEA)对妊高征剖宫产患者血液流变学的影响。方法对2013年1月至2014年7月在我院诊治的96例妊高征剖宫产患者进行研究,按麻醉方式不同分为观察组与对照组,每组48例患者。观察组患者实施蛛网膜下隙与硬膜外联合阻滞麻醉方式,对照组患者实施硬膜外阻滞(EB)的麻醉方式,并检测两组患者的血液流变学指标。结果观察组的麻醉药总用量、麻醉起效时间、达到最高痛觉平面时间以及VAS评分、Bromage评分组间比较存在显著性差异,具有可比性和统计学意义(P<0.01);两组新生儿Apgar评分相比未有明显差异(P>0.05);麻醉前,两组患者的血浆黏度、全血黏度的组间比较均无明显差异(P>0.05);麻醉生效期间,两组患者的血浆黏度、全血黏度与麻醉前组内比较差异显著(P<0.05),组间对比均存在显著性差异,有可比性和统计学意义(P<0.05);娩出后,观察组和对照组患者的血浆黏度、全血黏度较麻醉前均下降,与麻醉前相比,组内比较有显著差异(P<0.05),与麻醉中比较无明显差别(P>0.05),但观察组的血浆黏度、全血黏度明显低于对照组,组间比较存在的差异显著,具有可比性和统计学意义。结论蛛网膜下隙与硬膜外联合阻滞麻醉效果显著,能有效改善妊高征剖宫产患者的血液流变学状态,是一种安全有效的麻醉方式,值得临床应用。

Objective This study aimed to research the impact of CSEA on hemorheology in PIHS cesareanpatients.Methods 96casesofPIHScesareanpatientswhowerediagnosedinourhospitalduring January 2013 and July 2014 were selected as study subject.They were divided into observation group and control group according to different anesthesia method and 48 patients in each group.Patients in observation group were given of 48 CSEA while patients in control group received EB anesthesia.Results There was an obvious difference in anesthetic effect index between the two groups （P〈0.01）, but no significant difference in newborns＇ Apgar score （P〉0.05）.Differences of plasma and blood viscosity between the two groups were not statistically significant before anesthesia （P〉0.05）.During anesthesia became effective, differences of plasma and blood viscosity compared to that before anesthesia were statistically significant （P 〈0.05）, there were also obvious differences between the two groups （P〈0.05）.After delivery, plasma and blood viscosity of both groups were decreased compared with that before and there was a significant difference within groups （P〈0.05）, but there was no significant difference compared to that during anesthesia （ P 〉0.05）, plasma and blood viscosity of observation group was lower than control group, differences between the two groups were statistically significant （P〈0.05）.Conclusions The anesthetic effect of CSEA is significant, it can effectively improve hemorheology state of PIHS cesarean patients, it is a safe and effective manner and worthy of clinical application.