肥胖产妇剖宫产术不同体位下腰硬联合麻醉镇痛效果及对血流动力学和新生儿结局影响

Analgesic effect of spinal-epidural anesthesia in different position of obese women during cesarean section and its influence on their hemodynamic and neonatal outcomes

目的:探讨不同体位下腰硬联合麻醉对肥胖产妇剖宫产术的镇痛效果及对血流动力学和新生儿结局的影响.方法:收集本院2020年8月-2021年8月收治的95例肥胖产妇,根据术前腰硬联合麻醉体位穿刺方式不同分组,分别采用坐位穿刺腰硬联合麻醉(坐位组50例)、侧卧位穿刺腰硬联合麻醉(侧卧组45例),比较两组临床效果.结果:麻醉后,坐位组镇痛效果、肌松效果均优于侧卧组,血流动力学相关指标改善优于侧卧组,不良反应发生率(6.0%)低于侧卧组(20.0%)(均P<0.05),新生儿Apgar评分(8.64±1.36分)与侧位组(8.62±1.49分)无差异(P>0.05).结论:坐位下腰硬联合麻醉对肥胖产妇剖宫产术镇痛效果更佳,可改善产妇血流动力学指标并降低不良反应发生,且不影响新生儿结局.

Objective: To investigate the analgesics effect of spinal-epidural anesthesia in different position of obese women during cesarean section, and to study its influence on their hemodynamic and neonatal outcomes. Methods: 95 obese pregnant women who wanted cesarean section were selected and were divided into two groups according to the different puncture method and position during spinal-epidural anesthesia. 50 women in group A were treated with spinal-epidural anesthesia in the sitting position, while 45 women in group B were treated with spinal-epidural anesthesia in the lateral decubitus position. The clinical efficacy of the women was compared between the two groups. Results: The analgesic effect and muscle relaxation effect of the women in group A after anesthesia were significantly better than those of the women in group B, the improvement of the hemodynamic indexes of the women in group A was significantly better than that of the women in group B. The incidence of adverse reactions(6.0%) of the women in group A was significantly lower than that(20.0%) of the women in group B(all P<0.05). There was no significant difference in Apgar score(8.64±1.36 points vs.8.62±1.49 points) of newborns between the two groups(P>0.05). Conclusion: Spinal-epidural anesthesia in the sitting position for obese women during cesarean delivery has better analgesic effect, and which can improve the hemodynamic parameters and reduce the incidence of adverse effects of the women without affecting neonatal outcomes.