蛛网膜下隙联合硬膜外麻醉坐位和卧位穿刺在剖宫产麻醉中的效果比较

Comparison of the effect of subarachnoid space combined with epidural anesthesia in sitting and supine puncture in cesarean section anesthesia

目的:总结分析剖宫产术前蛛网膜下隙联合硬膜外麻醉时坐位和卧位穿刺的应用效果。方法:选择2020年4月—2021年3月择期实施剖宫产手术产妇100例,按计算机随机数字表法分为坐位组(50例)和侧卧位组(50例)。坐位组产妇麻醉穿刺时采用坐位行腰硬联合麻醉;侧卧位组产妇以左侧卧位行腰硬联合麻醉。观察两组产妇入室时(t_(0))、摆好体位时(t_(1))、给药后(t_(2))、平卧时(t_(3))、平卧5 min(t_(4))、手术开始时(t_(5))不同时间的血压(舒张压和收缩压)、心率(HR)和穿刺成功时间、置管成功时间、置管后到平卧的时间及手术开始的时间;统计两组新生儿情况及患者对麻醉穿刺过程的舒适满意度。结果:坐位组t_(1)和t_(2)时刻收缩压和舒张压明显高于侧卧位组,差异有统计学意义(P<0.05);侧卧位组t_(0)和t_(5)时刻心率高于坐位组,t_(1),t_(2),t_(3),t_(4)时刻心率低于坐位组,差异有统计学意义(P<0.05)。两组穿刺成功时间、置管成功时间、置管后到平卧的时间、新生儿的情况(新生儿窒息、窘迫及阿普加(Apgar)评分、产妇对麻醉穿刺过程的舒适满意度比较,差异无统计学意义(P>0.05)。结论:蛛网膜下隙联合硬膜外麻醉用于剖宫产手术麻醉效果安全有效,坐位穿刺对血流动力学的影响更小,患者舒适满意度更高,尤其适用于剖宫产手术的肥胖产妇。

Objective:To summarize and analyze the application effect of sitting and supine puncture in the subarachnoid space combined with epidural anesthesia before cesarean section.Methods:From April 2020 to March 2021,100 cases of elective cesarean section in hospital were selected,and they were randomly divided into a sitting group of 50 cases and a lateral decubitus group of 50 cases by computer random number table method.The puerperae in the sitting group received combined spinal-epidural anesthesia in the sitting position during anesthesia and puncture,the puerperae in the lateral decubitus group received combined spinal-epidural anesthesia in the left lateral position.The blood pressure(diastolic blood pressure)of the puerperae in the two groups at the time of entering the room(t_(0)),when the body position was established(t_(1)),after administration(t_(2)),when lying supine(t_(3)),5 minutes in the supine position(t_(4)),and at the beginning of the operation(t_(5))were observed.and systolic blood pressure)and heart rate(HR),the successful time of puncture,the time used for catheterization,the time used to lie down after catheterization,the time to start the operation,the time to reach the anesthesia level were observed.The scores of the neonates in the two groups and the comfort satisfaction of the patients with the anesthesia puncture process were calculated.Results:The systolic blood pressure and diastolic blood pressure at t_(1) and t_(2) in the sitting group were significantly higher than those in the lateral lying group,and the difference was statistically significant(P<0.05).In the lateral position group,the heart rate increased at t_(0) and t_(5),and decreased at t_(1),t_(2),t_(3),t_(4),and the difference was statistically significant(P<0.05).There was no significant difference in the time of successful puncture,successful catheter placement,supine time after catheter placement,neonatal conditions(neonatal asphyxia,distress and Apgar score),and maternal satisfaction with the anesthesia and puncture process between the two groups(P>0.05).Conclusion:Subarachnoid combined epidural anesthesia is safe and effective for cesarean section anesthesia.Sitting puncture has less influence on hemodynamics and higher patient satisfaction.It is especially suitable for cesarean section for obese women.