不同麻醉方法在妊娠期糖尿病产妇行剖宫产手术中的麻醉效果比较

Comparison of anesthesia effects of different anesthesia methods on cesarean section of pregnant women with gestational diabetes mellitus

目的比较不同麻醉方法在妊娠期糖尿病产妇行剖宫产手术中对血流动力学、激素水平、趋化素及不良反应的影响。方法选取2019年1-9月在该院行剖宫产手术的妊娠期糖尿病单胎头位初产妇220例为研究对象。根据麻醉方式分为观察组(腰硬联合麻醉,n=112)和对照组(硬膜外麻醉,n=108)。观察两组产妇麻醉前(T0)、给药后5 min(T1)、给药后15 min(T2)、给药后30 min(T3)、手术结束(T4)的平均动脉压(MAP)及心率变化;检测两组产妇在T0、T4时血液激素水平,血液激素5项检测项目为卵泡生成激素(FSH)、黄体生成激素(LH)、雌二醇(E2)、睾酮(TT)、催乳素(PRL);检测两组产妇在T0、T3时血清趋化素水平,检测方法选择ELISA法,采用趋化素1试剂盒(48T/96T)进行趋化素检测;观察两组产妇麻醉期间血压下降、心率减慢、恶心呕吐、呼吸抑制等麻醉不良反应。结果组内比较,对照组产妇MAP、心率和观察组产妇心率在T1-T4时间点变化差异有统计学意义(P<0.05),观察组产妇MAP在T1-T4时间点变化差异无统计学意义(P>0.05);组间比较,观察组产妇在T1-T4时间点MAP均高于对照组产妇,心率均低于对照组产妇,差异有统计学意义(P<0.05)。观察组产妇在T4时间点TT、E2、FSH、PRL及LH水平均高于对照组产妇,差异有统计学意义(P<0.05);观察组产妇血清趋化素在T3时低于对照组产妇(P<0.05)。观察组和对照组产妇麻醉不良反应发生率分别为2.68%和11.11%,组间差异有统计学意义(P<0.05)。结论妊娠期糖尿病产妇行剖宫产手术采用腰硬联合麻醉效果明显,麻醉期间血流动学平稳,对促性腺激素、雌激素、TT、PRL水平影响较小,可降低趋化素的水平,减少不良反应的发生,安全可靠,值得推广。

Objective To compare the effects of different anesthesia methods on hemodynamics,hormone level,chemokine and adverse reactions in cesarean section of gestational diabetic mellitus pregnant women.Methods A total of 220 primiparas with gestational diabetes mellitus needed cesarean section were selected into this study from January to September 2019,and divided into two groups according to different anesthesia methods,including observation group(combined lumbar and epidural anesthesia,n=112)and control group(epidural anesthesia,n=108).The changes of mean arterial pressure(MAP)and heart rate were observed before anesthesia(T0),5 minutes after administration(T1),15 minutes after administration(T2),30 minutes after administration(T3),and at the end of operation(T4).The blood hormone levels of the two groups were measured at T0 and T4 including follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),testosterone(TT)and prolactin(PRL).The ELISA was used to detect the chemokine like factors at T0 and T3 of the two groups with chemokines 1 Kit(48 T/96 T).To observe the adverse reactions such as blood pressure drop,heart rate slowing,nausea and vomiting,respiratory depression between the two groups during anesthesia.Results There were statistical differences on the changes of maternal heart rat and MAP in the control group at T1-T4(P<0.05).There were statistical differences on the changes of heart rat in the observation group at T1-T4(P<0.05).There was no significant difference on the MAP in the observation group at T1-T4(P>0.05).MAP in the observation group was higher than that in the control group at T1-T4,and the heart rat was lower than that in the control group(P<0.05).The observation group had higher TT,E2,FSH,PRL and LH levels at T4 compared with the control group(P<0.05).The serum chemokines in the observation group was lower than that in the control group at T3(P<0.05).The incidence of adverse reactions in the observation group and the control group were 2.68%and 11.11%respectively,the difference between the two groups was statistically significant(P<0.05).Conclusion The cesarean section of gestational diabetes mellitus with combined spinal and epidural anesthesia has obvious effect.The blood flow is stable during anesthesia,combined spinal and epidural anesthesia has less effect on gonadotropin,estrogen,TT and PRL levels,lowering the level of chemokines and reducing the occurrence of adverse reactions,which is safe and reliable and worth promoting.