不同麻醉方式在剖宫产术中的应用比较

Different anesthetic techniques in cesarean section

目的观察和比较腹横肌平面阻滞复合七氟醚全麻与腰硬联合麻醉对剖宫产手术产妇血流动力学影响及麻醉实施时间、产科医师及产妇满意度。方法选择拟行剖宫产的足月妊娠产妇60例,ASAⅠ~Ⅱ级,分为腹横肌平面阻滞联合七氟醚全麻组(T组)和腰硬联合麻醉组(C组),每组30例。T组产妇采用双侧腹横肌平面阻滞后,七氟醚吸入诱导插入喉罩;C组产妇采用椎管内麻醉。记录麻醉前(T1)、麻醉后2 min(T2)、切皮时(T3)、娩出胎儿后5 min(T4)、手术结束(T5)各时点产妇心率(HR)、平均动脉压(MAP)的变化,记录麻醉实施时间、产科医师及产妇满意度、术中出血量及新生儿Apgar评分。结果组内比较,T组术中HR、MAP变化与麻醉前比较差异无统计学意义(P>0.05);C组产妇T2时HR升高,MAP下降,T4时MAP升高(P<0.05);组间比较,T组产妇T2时点HR低于C组,T2、T3时点MAP高于C组(P<0.05);两组新生儿Apgar评分差异无统计学意义(P>0.05)。麻醉实施所需时间T组较C组明显缩短(P<0.05),产科医师满意度及产妇满意度T组高于C组(P<0.05)。结论腹横肌平面阻滞联合七氟醚全麻对产妇血流动力学及胎儿影响小,麻醉时间明显缩短,产科医师与产妇满意度高,可安全应用于剖宫产。

Objective To observe and compare haemodynamics,anesthesia time and satisfaction of obstetricians and in cesarean section parturients among transversus abdominis plane block combined sevoflurane general anesthesia and combined spinal and epidural analgesia. Methods Sixty full-term pregnant women（ ASA Ⅰ-Ⅱ） were divided to transversus abdominis plane block combined sevoflurane general anesthesia group（ Group T,n = 30） and combined spinal and epidural analgesia group（ Group C,n = 30）. Parturients received sevoflurane inhalation after bilateral transversus abdominis plane block in Group T,and those in Group C received intraspinal anesthesia. Heart rates（ HR） and mean arterial pressure（ MAP） were recorded before anesthesia（ T1）,2 min after anesthesia（ T2）,at skin incision（ T3）,5 min after delivery（ T4） and at the end of surgery（ T5）. Moreover,anesthesia time,satisfaction of obstetricians and parturients,intraoperative blood loss and neonatal Apgar score were recorded. Results There were no significant differences in HR or MAP before and after anesthesia in Group T（ P〉 0. 05）. Compared with baseline,HR was significantly higher and MAP was significantly lower at T2 in Group C,but MAP was significantly increased at T4（ P〈 0. 05）. In Group T,HR was significantly lower at T2,and MAP was significantly higher at T2 and T3,compared to those in Group C（ P〈 0. 05）.There were no significant differences in Apgar score between the two groups（ P 〉 0. 05）. Anesthesia time was shorter and satisfaction of obstetricians and parturients were significantly higher in Group T group than Group C（ P 〈 0. 05）. Conclusion Transversus abdominis plane block combined sevoflurane general anesthesia influences little haemodynamics of parturients and fetus,provides shorter anesthesia time,higher satisfaction of obstetricians and parturients.