利多卡因硬膜外麻醉复合异丙酚对剖宫产术镇痛效果及对患者血浆凝血酶原时间、纤维蛋白原的影响

Influences of lidocaine epidural anesthesia combined with propofol on analgesic effect,plasma prothrombin time and fibrinogen in patients with cesarean section

目的:探究利多卡因硬膜外麻醉复合异丙酚对剖宫产患者镇痛效果及对血浆凝血酶原时间(PT)、血浆纤维蛋白原(FIB)的影响。方法:选择行剖宫产分娩的86例产妇为研究对象,并以随机数字表将其分为两组,观察组、对照组各43例。两组均行硬膜外麻醉,对照组术中持续注入利多卡因进行麻醉,观察组在对照组基础上加用异丙酚进行麻醉。比较两组麻醉效果、术中生命体征参数及不同分娩阶段的疼痛情况,观察术前、术后产妇凝血功能的改变,统计不良反应发生率。结果:观察组产妇麻醉总有效率93.02%显著高于对照组72.09%(P<0.05),术中血压、心率、平均动脉压均明显低于对照组,血氧饱和度明显高于对照组(均P<0.05);观察组产妇在切皮、腹膜牵拉、胎儿娩出、术毕等不同分娩阶段疼痛视觉模拟量表(VAS)评分均明显低于对照组(均P<0.05);PT、FIB术前两组比较差异无统计学意义(P>0.05);而术后6 h,两组产妇相对于术前显著降低,且观察组更显著(P<0.05)。观察组产妇打鼾、恶心呕吐、躁动、精神不振等总不良反应发生率显著低于对照组(P<0.05)。结论:对剖宫产产妇应用利多卡因复合异丙酚硬膜外麻醉总有效率高,术中镇静、镇痛效果好,有助于产妇术后凝血功能恢复,降低不良反应发生率。

Objective:To explore the influences of lidocaine epidural anesthesia combined with propofol on the analgesic effect,blood prothrombin time(PT)and plasma fibrinogen(FIB)in patients with cesarean section.Methods:Eighty-six parturients who underwent cesarean delivery were selected as the research objects,and they were divided into observation group and control group,with 43 cases in each.Both groups underwent epidural anesthesia.The control group was continuously injected with lidocaine during the operation for anesthesia,and the observation group was anesthetized with propofol on the basis of the control group.The effects of anesthesia,intraoperative vital sign parameters and pain at different stages of delivery were compared between the two groups.The changes in the coagulation function of the parturients before and after the operation were observed.The incidence of adverse reactions was counted.Results:The total effective rate of the observation group was 93.02%,which was significantly higher than 72.09%of the control group(P<0.05).The intraoperative blood pressure,heart rate and mean arterial pressure of the observation group were significantly lower than those of the control group,and the blood oxygen saturation was significantly higher than that of the control group(all P<0.05).The VAS scores in different stages of delivery,such as skin incision,peritoneal traction,fetal delivery,and the end of operation,of the observation group were significantly lower than those of the control group(all P<0.05).There was no statistically significant difference in PT and FIB between the two groups before operation(all P>0.05);but at 6 hours after operation,the two groups of parturients were significantly lower than those before surgery,and the observation group was more significant(all P<0.05).The total incidence of adverse reactions of snoring,nausea and vomiting,restlessness,low spirits in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:The application of lidocaine combined with propofol epidural anesthesia for cesarean section has high total effective rate,good sedation and analgesic effect during operation,which is helpful to the recovery of blood coagulation function and reduce the incidence of adverse reactions.