腰硬联合麻醉与硬膜外麻醉在妊娠期高血压并发急性心力衰竭患者剖宫产中的应用效果比较

Comparative Study of Combined Spinal Epidural Anesthesia and Epidural Anesthesia in Patients with Pregnancy Induced Hypertension Complicated with Acute Heart Failure during Cesarean Section

目的:探讨腰硬联合麻醉与硬膜外麻醉应用于妊娠期高血压并发急性心力衰竭患者剖宫产的效果。方法:回顾性分析2015年1月-2020年1月本院100例妊娠期高血压并发急性心力衰竭患者的临床资料。依据临床急救与剖宫产麻醉处理方法分为观察组和对照组,每组50例。两组患者均进行临床急救,对照组采用硬膜外麻醉,观察组采用腰硬联合麻醉。比较两组的临床疗效、血压、麻醉效果、疼痛程度、不良妊娠结局情况、新生儿Apgar评分、不良反应发生情况。结果:观察组治疗总有效率为100%,显著高于对照组的72.0%,差异有统计学意义(P<0.05)。治疗后,两组舒张压、收缩压均显著低于治疗前,且观察组均显著低于对照组,差异均有统计学意义(P<0.05)。观察组的麻醉起效时间、最高麻醉平面时间、运动阻滞恢复时间、感觉阻滞恢复时间均显著短于对照组,差异均有统计学意义(P<0.05)。两组麻醉后5、20、30 min的VAS评分均逐渐降低(P<0.05);麻醉后5、20、30 min,观察组VAS评分均显著低于对照组,差异均有统计学意义(P<0.05)。观察组的不良妊娠结局发生率为2.0%,显著低于对照组的16.0%,差异有统计学意义(P<0.05)。观察组新生儿1 min Apgar评分2~3分且5 min Apgar评分4~6分比例显著低于对照组(P<0.05);1 min Apgar评分>7分且5 min Apgar评分>9分比例显著高于对照组(P<0.05)。观察组的不良反应发生率为6.0%,显著低于对照组的24.0%,差异有统计学意义(P<0.05)。结论:临床急救与剖宫产腰硬联合麻醉处理妊娠期高血压并发急性心力衰竭患者的效果较硬膜外麻醉好。

Objective:To study the effect of combined spinal epidural anesthesia and epidural anesthesia in patients with pregnancy induced hypertension complicated with acute heart failure during cesarean section.Method:Clinical data of 100 patients with gestational hypertension complicated with acute heart failure in our hospital from January 2015 to January 2020 were retrospectively analyzed.According to clinical emergency treatment and cesarean section anesthesia treatment,they were divided into observation group and control group,50 cases in each group.Patients in both groups were given clinical emergency treatment,the control group was given epidural anesthesia,and the observation group was given combined spinal epidural anesthesia.Clinical efficacy,blood pressure,anesthesia effect,pain,adverse pregnancy outcome,neonatal Apgar score and adverse reactions were compared between two groups.Result:The total effective rate of the observation group was 100%,which was significantly higher than 72.0% of the control group,the difference was statistically significant (P<0.05).After treatment,diastolic blood pressure and systolic blood pressure in two groups were significantly lower than those before treatment,and the observation group were significantly lower than those in the control group,the differences were statistically significant (P<0.05).The onset time of anesthesia,the time of maximum anesthesia level,the recovery time of motor block and the recovery time of sensory block in the observation group were significantly shorter than those in the control group,the differences were statistically significant (P<0.05).VAS scores of both groups were gradually decreased at 5,20 and 30 min after anesthesia (P<0.05).At 5,20 and 30 min after anesthesia,the VAS score of the observation group were significantly lower than those of the control group,the differences were statistically significant (P<0.05).The incidence of adverse pregnancy outcomes in the observation group was 2.0%,which was significantly lower than 16.0% in the control group,the difference was statistically significant (P<0.05).The proportion of Apgar score 2-3 at 1 min and 4-6 at 5 min in the observation group was significantly lower than that in the control group (P<0.05).The proportion of 1 min Apgar score >7 and 5 min Apgar score >9 in the observation group was significantly higher than that in the control group (P<0.05).The incidence of adverse reactions in the observation group was 6.0%,which was significantly lower than 24.0% in the control group,the difference was statistically significant (P<0.05).Conclusion:Clinical emergency treatment and combined spinal epidural anesthesia in cesarean section are better than epidural anesthesia in the treatment of patients with gestational hypertension complicated with acute heart failure.