不同穿刺体位在腰-硬联合麻醉剖宫产术中的比较

Comparison of different puncture positions for combined spinal-epidural anesthesia in cesarean section

目的比较不同穿刺体位在腰-硬联合麻醉（CSEA）剖宫产术中的效果。方法拟行剖宫产术的足月妊娠产妇90例,随机分为两组,每组45例。选择L3~4椎间隙作为穿刺点。R组右侧穿刺腰麻后保持穿刺体位2 min后左倾30°仰卧至手术开始,L组左侧穿刺腰麻后仰卧位,并调整手术床左倾30°直至手术开始。腰麻药物均为1.0%罗哌卡因1.5 ml＋10%葡萄糖0.5 ml。观察腰麻药物注入后15 min内产妇感觉阻滞效应及不良反应情况,记录新生儿Apgar评分,检测脐动脉血p H值。结果 R组产妇最终阻滞平面明显低于L组,达到最终阻滞平面所需时间明显短于L组（P〈0.05）。R组麻黄碱用量为0（0~6）mg,明显低于L组的6（0~12）mg（P〈0.05）。R组脐动脉血p H值明显高于L组（P〈0.05）。两组新生儿Apgar评分差异无统计学意义。结论剖宫产术采用右侧卧位穿刺注药后保持穿刺体位2 min后30°仰卧,其麻醉效果优于左侧卧位穿刺后30°仰卧体位。

Objective To compare the effect of different puncture positions in the combined spinal epidural anesthesia（ CSEA） in cesarean section. Methods Ninety uterogestation women undergoing elective Caesarean section were randomly divided into two groups,45 in each group. L3-4intervertebral space was selected as puncture point. Group R kept right lateral position for two minutes after puncture and turned30° left tilt supine position until ready for surgery. Group L was turned to supine position after left lateral punctured and then turned to 30 left tilt supine position until ready for surgery. 1% ropivacaine 1. 5 ml ＋10% glucose 0. 5 ml was used for spinal anesthesia. The sensory block level and adverse reaction within 15 min after the spinal anesthesia were observed,and the neonatal Apgar score and the p H value of umbilical artery blood were recorded. Results The final block level of the group R was significantly lower than group L,and the time achieving final block height was significantly shorter than that in group L（ P〈0. 05）. The ephedrine dosage of group R 0（ 0-6） mg was significantly lower than that of group L6（ 0-12） mg（ P〈0. 05）. The PH value of umbilical artery blood in group R was significantly higher than that in group L（ P〈0. 05）. There was no significant difference in neonatal Apgar score. Conclusion In Cesarean section,keeping right lateral puncture position for two minutes after infusion and then turning 30° left tilt supine position can achieve better effects than 30° left tilt supine position immediately after puncturing.