不同麻醉方法对妊娠期高血压疾病患者剖宫产术母婴的影响

Effects of different anesthetic methods on maternal and infant in patients with hypertensive disorders complicating pregnancy undergoing cesarean section

目的研究不同麻醉方法对妊娠期高血压疾病患者剖宫产术母婴的影响。方法将2016年1月至2017年1月该院收治的择期行剖宫产术的280例妊娠期高血压疾病患者分为A、B、C、D组,每组70例。A组实施蛛网膜下腔麻醉联合硬膜外阻滞麻醉,B组实施硬膜外阻滞麻醉,C组实施蛛网膜下腔麻醉,D组实施气管内插管全身麻醉。比较四组患者麻醉前(t_1)、麻醉后5 min(t_2)、10 min(t_3)、20 min(t_4)、30 min(t_5)、胎儿娩出时(t_6)及术毕(t_7)各时间点的平均动脉压(MAP)、心率(HR)及脉搏血氧饱和度(SpO_2);比较四组胎儿t_1、t_2及手术开始即刻各时间点的胎心率和新生儿娩出后1、5、10 min的Apgar评分及脐血pH值。结果四组患者t_2~t_7时MAP、HR均明显低于t_1时,C组患者t_3~t_7时MAP均明显低于其他三组,B组患者t_3~t_7时HR均明显低于其他三组,差异均有统计学意义(P<0.05);四组患者各时间点SpO_2比较,差异均无统计学意义(P>0.05);四组胎儿t_2、手术开始即刻胎心率变化与t_1比较,差异均无统计学意义(P>0.05),组间比较,差异也均无统计学意义(P>0.05);四组胎儿娩出后5、10 min的Apgar评分及脐血pH值变化与娩出后1 min比较,差异均无统计学意义(P>0.05),组间比较,差异也均无统计学意义(P>0.05)。结论蛛网膜下腔麻醉联合硬膜外阻滞麻醉、硬膜外阻滞麻醉、蛛网膜下腔麻醉和气管内插管全身麻醉均适用于妊娠期高血压疾病患者剖宫产术的麻醉。

Objective To research the effects of different anesthesia methods on maternal and infant in the patients with hypertensive disorders complicating pregnancy undergoing cesarean section. Methods A total of 280 cases of hypertensive disorders complicating pregnancy undergoing elective cesarean section in this hospital from January 2016 to January 2017 were divided into the group A,B,C and D,70 cases in each group. The group A carried out lumbar anesthesia combined epidural blocking anesthesia,the group B implemented epidural blocking anesthesia,the group C conducted subarachnoid space block anesthesia and the group D carried out general anesthesia with endotracheal intubation. The mean artery pressure（MAP）,heart rate（HR） and oxyhemoglobin saturation（SpO_2） before anesthesia（t_1）,at 5 min（t_2）,10 min（t_3）,20 min（t_4） and 30 min（t_5） after anesthesia,at fetal delivery（t_6） and end of operation（t_7） were compared among 4 groups;the fetal heart rate before anesthesia,at 5 min after anesthesia and instantly beginning of operation,Apgar score at 1,5,10 min after newborn delivery and pH value of umbilical cord blood were compared among 4 groups. Results MAP and HR at t_2-t_7 in 4 groups were significantly lower than those at t_1;MAP at t_3-t_7 in the group C were significantly lower than those in the other 3 groups,HR at t_3-t_7 in the group B was significantly lower than that in the other 3 groups,the differences were statistically significant（P〈0.05）;SpO_2 at each time point had no statistical difference among4 groups（P〈0.05）;HR change at t_2 and instantly after t_1 in 4 groups had no statistical difference compared with before anesthesia（P〈0.05）;the inter-group comparison showed no statistical difference（P〈0.05）;the Apgar score at 5,10 min after birth and umbilical cord blood pH value change had no statistical difference compared with those at 1 min after birth（P〈0.05）;the inter-group comparison also showed no statistical difference（P〈0.05）. Conclusion Lumbar anesthesia combined with epidural blocking anesthesia,epidural blocking anesthesia,subarachnoid space block anesthesia and general anesthesia with endotracheal intubation all are suitable for anesthesia of cesarean section in the patients with hypertensive disorders complicating pregnancy.