腰硬联合麻醉在不同体位剖宫产中的实施效果及对新生儿的影响

Effect of Combined Spinal-Epidural Anesthesia in Different Postural Cesarean Section and its Effect on Neonates

目的探讨腰硬联合麻醉在不同体位剖宫产产妇中的实施效果及对新生儿的影响。方法选取2015年2月—2016年12月我院行剖宫产产妇138例为研究对象,根据患者腰硬联合麻醉后采取不同体位分为A组(平卧位,40例)、B组(手术床脚端抬高20°,50例)、C组(手术床左侧倾斜20°,48例),比较三组患者麻醉起效时间及麻醉前(T0)、麻醉1 min(T1)、麻醉2 min(T2)、麻醉5 min(T3)、麻醉10 min(T4)的平均动脉压(MAP)及新生儿并发症发生率。结果 B组麻醉起效时间显著短于A、C两组,差异有统计学意义(P<0.05)。麻醉前三组患者MAP水平无明显差异,麻醉后三组患者MAP均有下降,B组下降程度显著于A、C两组,A组下降程度显著于C组,差异有统计学意义(P<0.05)。B组胎儿窘迫发生率显著高于A、C两组,胎心异常、新生儿窒息发生率高于C组,差异有统计学意义(P<0.05)。结论剖宫产手术患者腰硬联合麻醉后将手术床左侧倾斜可有效预防麻醉后低血压发生风险,维持患者血液动力学稳定,降低新生儿并发症发生率。

Objective To explore the effect of combined spinal - epidural anesthesia in different postures of cesarean section and the effect on neonatal. Methods 138 case of puerperae to undergo cesarean section during Feb. ,2015 to D e c . , 2016 were included in the study and they were then divided according to their different positions during spinal epidural anes-thesia into group A （ supine position, 40 cases） , group B （the end of operating bed raised by 20 °, 50 cases） , group C （the operating table inclined to its left side by 20 °, 48 cases）. The groups were compared between the groups in terms of pre - anesthesia （ TO） , anesthesia for 1 min （ T1） , anesthesia for 2 min （ T2） , anesthesia for 5 min （ T3 ） , anesthesia for 10 min （T4） mean arteries （MAP） , and the incidence of complications. Results Anesthesia onset time of group B was significant-ly shorter than groups A, C （P 〈 0. 05 ）. There was no significant difference in MAP level between the three groups before anesthesia, MAP was decreased in all three groups after anesthesia, but its decrease in group B was statistically significant in group A and C, and the decrease in group A was statistically significant in group C （ P 〈 0. 05 ）. The incidence of fetal dis-tress in group B was significantly higher than that in group A and C, and the incidence of neonatal asphyxia was significantly higher than that of group C （ P 〈 0. 05 ） . Conclusion Lumbar and epidural anesthesia with the operating table inclined to the left side for the patients undergoing cesarean section can effectively prevent the risk of hypotension after anesthesia, main-tain hemodynamic stability and reduce incidence of neonatal complications.