氨茶碱预应用对腰-硬联合麻醉下剖宫产产妇术后硬脊膜穿刺后头痛的影响

Effect of Aminophylline Pre-Application on Post-Dural Puncture Headache in Women After Cesarean Section Under Combined Combined Spinal-Epidural Anesthesia

目的:探讨在腰-硬联合麻醉下剖宫产术后硬脊膜穿刺后头痛产妇中预应用氨茶碱的效果。方法:选取行剖宫产的90例产妇,均采用腰-硬联合麻醉,随机分为观察组(n=45)和对照组(n=45);观察组术中给予氨茶碱预应用,对照组同时刻给予等量生理盐水,均为静脉输注,比较2组产妇术后硬脊膜穿刺后头痛发生率、视神经鞘直径、血流动力学变化、术后不良反应发生情况。结果:2组硬脊膜穿刺后头痛发生率比较,观察组(4.44%)低于对照组(17.78%),差异有统计学意义(P<0.05);2组术前视神经鞘直径比较差异无统计学意义(P>0.05),观察组麻醉后、术后分别为(5.05±0.14)mm、(5.11±0.25)mm,低于对照组的(5.34±0.46)mm、(5.48±0.67)mm;2组血流动力学指标变化情况及术后不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:氨茶碱具有降低视神经鞘直径、缓解颅内压降低、减轻痛觉传递的作用,在术中静脉输注氨茶碱能够显著降低术后头痛发生率,且安全性良好。

Objective:To investigate the effect of the pre-application of aminophylline in women with post-dural puncture headaches af-ter cesarean section under combined spinal-epiduralanesthesia.Methods:90 cases who underwent cesarean section,using combined spinal-epi-dural anesthesia,were selected and divided into the observation group(n=45)and the control group(n=45)according to the random number table method.The women in the observation group were given intraoperative aminophylline pre-application,while the women in the control group were given the same amount of saline,and the method was both intravenous infusion.the incidence of postoperative dural puncture headache,optic nerve sheath diameter,hemodynamic changes,and postoperative adverse reactions were compared between the two groups.Results:The incidence of postoperative dural puncture headache was 4.44%in the observation group and 17.78%in the control group,and the comparison showed a significant difference(P<0.05);the diameter of the optic nerve sheath was not significantly different between the two groups before surgery(P>0.05),and the diameter of the optic nerve sheath in the observation group after anesthesia(5.05±0.14)mm and af-ter surgery(5.11±0.25)mm were significantly lower than that in the control group(P<0.05).There were no significant differences in the changes of hemodynamic indexes and the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion:Aophyl-line has the effect of reducing the diameter of the optic nerve sheath,alleviating the reduction of intracranial pressure,and reducing pain transmission.Intravenous infusion of aminophylline can significantly reduce the incidence of postoperative headache and reduce the degree of headache,and the study results suggest good safety and high clinical application value.