妊娠期高血压疾病产妇剖宫产麻醉方式的选择和应用效果分析

Analysis of the selection and application effect of anesthesia for cesarean section in puerperae with gestational hypertension

目的对比分析不同麻醉方式在妊娠期高血压疾病产妇剖宫产术中的临床应用效果。方法选取2015年1月—2020年12月舟山市妇女儿童医院收治的120例妊娠期高血压疾病剖宫产产妇为研究对象,随机分成单纯硬膜外麻醉组和腰硬联合麻醉组,每组各60例。对比分析不同麻醉方式的临床效果。结果腰硬联合麻醉组产妇麻醉起效时间、运动阻滞恢复时间及感觉阻滞恢复时间[(8.85±0.85)min、(118.54±10.24)min及(165.33±18.36)min]均显著低于单纯硬膜麻醉组[(19.87±2.45)min、(190.75±18.66)min及(230.44±25.53)min],差异均有统计学意义(t=28.61、12.41及14.85,均P<0.05)。相对于单纯硬膜外麻醉组,腰硬联合麻醉组产妇舒张压、收缩压及心率更稳定。腰硬联合麻醉组产妇术后不同时点VAS评分[术后3 h(4.00±0.11)分、术后6 h(4.05±0.14)分、术后12 h(3.11±0.65)分、术后18 h(2.52±0.54)分及术后24 h(2.32±0.22)min]均低于单纯硬膜组[术后3 h(4.22±0.14)分、术后6 h(4.34±0.21)分、术后12h(3.98±0.46)分、术后18 h(3.33±0.34)分及术后24 h(3.01±0.06)min],差异均有统计学意义(t=1.12、2.63、6.87、11.67及12.63,均P<0.05)。腰硬联合麻醉组产妇不良反应发生率(11.67%)低于单纯硬膜组(25.00%),差异有统计学意义(χ^(2)=4.27,P<0.05)。结论妊娠期高血压疾病产妇剖宫产术中采用腰硬联合麻醉,具有良好的麻醉效果,能更好地维持产妇血压和心率稳定,减轻疼痛,并降低不良反应发生率,值得临床推广和应用。

Objective To compare and analyze the clinical application effect of different anesthesia methods in cesarean section for women with gestational hypertension.Methods A total of 120 puerperae with gestational hypertension who were admitted to Zhoushan Women’s and Children’s Hospital from January 2015 to December 2020 were selected as the research objects and randomly divided into a simple epidural anesthesia group and a combined spinal-epidural anesthesia group,60 cases in each group.The clinical effects of different anesthesia methods were compared and analyzed.Results The onset time of anesthesia,motor block recovery time and sensory block recovery time[(8.85±0.85)min,(118.54±10.24)mim and(165.33±18.36)min]in the spinal-epidural combined anesthesia group were significantly lower than In the simple dural anesthesia group[(19.87±245)min,(190.75±18.66)min and(230.44±25.53)mim],the differences were statistically significant(t=28.61,12.41 and 14.85,all P<0.05).Compared with the simple epidural anesthesia group,the diastolic blood pressure,systolic blood pressure and heart rate of the puerperae in the combined spinal-epidural anesthesia group were more stable.The VSA scores of puerperae in the combined spinal-epidural anesthesia group at different time points after operation[3 h after operation(4.00±0.11)points,6 h after operation(4.05±0.14)points,12 h after operation(3.11±0.65)points,18 h after operation(2.52±0.14)points after operation 0.54)points and 24 h(2.32±0.22)min]were lower than those of the pure dural group[3 h(4.22±0.14)points,6 h(4.34±0.21)points,12 h(3.98±0.46)points after operation score,18 h(3.33±0.34)points after operation and 24 h(3.01±0.06)min after operation],the differences were statistically significant(t=1.12,2.63,6.87,11.67 and 12.63,all P<0.05).The incidence of maternal adverse reactions in the combined spinal-epidural anesthesia group(11.67%)was lower than that in the simple dural group(25.00%),and the difference was statistically significant (χ^(2)=4.27,P<0.05).Conclusion Combined spinal-epidural anesthesia has good anesthesia effect in cesarean section for women with gestational hypertension.It can better maintain the stability of maternal blood pressure and heart rate,reduce pain,and reduce the incidence of adverse reactions.