腰硬联合麻醉中不同麻醉体位对剖宫产产妇及其新生儿的影响分析

Analysis of the effect of different anesthesia postures on cesarean section and the newborns under combined spinal epidural anesthesia

目的:研究不同麻醉体位蛛网膜下腔阻滞硬膜外阻滞(腰硬)联合麻醉对剖宫产产妇及其新生儿的影响。方法:收集2015年2月-2017年1月剖宫产(腰硬))合麻醉产妇46例分两组,左侧卧组采用左侧卧位蛛网膜下腔阻滞硬膜外阻滞(腰硬)联合麻醉;坐位组采用坐位蛛网膜下腔阻滞硬膜外阻滞(腰硬)联合麻醉。就两组产妇麻醉前后5min心率、舒张压、收缩压情况和麻醉满意度、新生儿出生后阿氏评分进行比较。结果:坐位组麻醉满意度和左侧卧组均为100%,P>0.05。坐位组新生儿出生后阿氏评分一分钟为(9.22±0.53)分,五分钟评分为(9.56±0.92)分,左侧卧组新生儿出生后阿氏评分一分钟为(9.21±0.45)分,五分钟评分为(9.46±0.57)分,坐位组新生儿出生后阿氏评分和左侧卧组相似,P>0.05。两组麻醉前5min心率、舒张压、收缩压情况相似,P>0.05。坐位组产妇麻醉后5min心率、舒张压、收缩压情况均明显优于左侧卧组,P<0.05。结论:不同麻醉体位蛛网膜下腔阻滞硬膜外阻滞(腰硬)联合麻醉对剖宫产产妇可产生影响,其中坐位麻醉可减少血流动力学波动,而对新生儿无明显影响。

Objective:To study the effect of subarachnoid block combined with epidural block(waist hard)with different anesthesia positions on cesarean section and the newborns.Methods:46cases of combined anesthesia for cesarean section from February2015to January2017were divided into two groups.The left lateral decubitus group was treated by left lateral decubitus subarachnoid block combined with epidural block(lumbar hard)anesthesia,sitting group was treated with sitting subarachnoid space block combined with epidural block(waist hard)anesthesia.The heart rate,diastolic blood pressure,systolic blood pressure and anesthesia satisfaction5minutes before and after anesthesia were compared between two groups of mothers before and after birth.Results:The anesthesia satisfaction of the sitting group and left lateral decubitus group was100%,P>0.05.Apgar score of newborn a minute and five minutes after birth of the sitting group was(9.22±0.53)and(9.56±0.92)respectively while that of the left side group was(9.21±0.45)and(9.46±0.57)respectively,Apgar score of the sitting group and the left side group was similar,P>0.05.The heart rate,diastolic blood pressure and systolic blood pressure5minutes before anesthesia of two groups were similar,P>0.05.The heart rate,diastolic blood pressure and systolic blood pressure5minutes after anesthesia of the sitting group was significantly better than those of the left side group,P<0.05.Conclusion:Subarachnoid block combined with epidural block(waist hard)with different anesthesia positions could have effect on cesarean section,sitting anesthesia could reduce hemodynamic fluctuations,but it had no significant effect on newborns