剖宫产术应用腰-硬联合阻滞麻醉的镇痛效果及护理配合

Analgesic Effects and Nursing of Combined Spinal-epidural Anesthesia in Cesarean Section

目的:探讨剖宫产术应用腰-硬联合阻滞麻醉的镇痛作用及护理配合。方法:选取2015年4月—2017年1月当阳市人民医院收治的行剖宫产术患者90例作为研究对象,以随机数字表法分为观察组和对照组,每组45例。对照组患者给予单纯硬膜外麻醉,观察组患者给予腰-硬联合阻滞麻醉,两组患者均给予相应的麻醉护理配合。观察两组患者的镇痛效果,记录两组患者干预前、镇痛后即刻和镇痛后1 h的视觉模拟评分(visual analogue scale,VAS);比较两组患者局部麻醉药用量、平均起效时间,第一、第二及总产程的差异;比较两组新生儿Apgar评分及患者不良反应发生情况、催产素应用情况的差异。结果:观察组患者镇痛总有效率明显高于对照组,差异有统计学意义(P<0.05);镇痛后即刻及镇痛后1 h,观察组患者VAS评分明显低于对照组,差异均有统计学意义(P<0.05);观察组患者局部麻醉药用量、平均起效时间明显少于对照组,第一、第二及总产程明显短于对照组,差异均有统计学意义(P<0.05);两组患者不良反应发生率、催产素应用率的差异无统计学意义(P>0.05);分娩后1、6 min,两组新生儿Apgar评分的差异均无统计学意义(P>0.05)。结论:剖宫产术应用腰-硬联合阻滞麻醉的镇痛效果显著,患者产程较短,麻醉速度较快,局部麻醉药用量少,安全性高,辅以麻醉护理配合,可有效减轻患者疼痛。

OBJECTIVE ： To probe into the analgesic effects and nursing of combined spinal-epidural anesthesia in cesarean section. METHODS： 90 patients undergoing cesarean sections admitted into Dangyang People＇s Hospital from Apr. 2015 to Jan. 2017 were selected and divided to observation group and control group via random number table, with 45 cases in each group. The control group was treated with epidural anesthesia, while the observation group was given combined spinal-epidural anesthesia, both were given matched nursing. The analgesic effects were observed, the VAS scores of before intervention, immediately after analgesia and 1 h after analgesia of two groups were recorded ; the differences of the dosages of local anesthetic, average onset times, the first, the second and the total stage of labor of two groups were compared; the differences of Apgar scores, incidence of adverse reactions and application of oxytocin of two groups of newborns were compared. RESULTS ： The total effective rate of analgesia of the observation group was significantly higher than that of the control group, with statistically significant difference （ P 〈 0.05 ） ; the VAS scores of immediately after analgesia and 1 h after analgesia of the observation group were significantly lower than those of the control group, with statistically significant difference （ P 〈 0.05 ） ; the dosage of local anesthetic, average onset time, the first, the second and the total stage of labor of observation group was significantly less than those of the control group, with statistically significant difference （P 〈 0. 05 ） ; there were no statistical significances in the incidence of adverse reactions and application rate of oxytocin between two groups （P 〉 0.05 ）; there were no statistical significances in the Apgar scores of 1 rain and 6 min after delivery between two groups of newborns （ P 〉 0.05 ）. CONCLUSIONS： The analgesic effect of combined spinal-epidural anesthesia in cesarean section is remarkable, with shorter stage of labor, faster anesthesia, less dosage of local anesthetic and higher safety, which can effectively relieve pains assisted by matched nursing.