腰硬联合麻醉与全麻对妊高征产妇剖宫产术不良事件及母婴预后的影响

Influence of Combined Spinal-epidural Anesthesia and General Anesthesia on Adverse Events of Cesarean Section and Prognosis of Mother and Infant in Pregnant Women with Hypertension

【目的】探讨腰硬联合麻醉(CSEA)与全麻对妊高征产妇剖宫产术不良事件及母婴预后的影响。【方法】本院收治的84例妊高征产妇,随机分为两组,每组42例。所有产妇均行剖宫产手术,其中对照组给予全身麻醉,观察组给予CSEA。比较两组麻醉情况及围术期血流动力学指标的变化;比较两组新生儿出生后1 min、5 min的Apgar评分及新生儿娩出后脐动脉血气指标情况;比较两组住院期间麻醉相关不良事件发生情况及母婴预后情况。【结果】观察组的麻醉起效时间、麻醉开始至娩出时间均长于对照组(P<0.05)。胎儿娩出时(T_(1)),两组心率、平均动脉压较麻醉前(T_(0))明显降低(P<0.05);手术结束时(T_(2)),两组心率较T_(0)、T_(1)明显升高,两组平均动脉压低于T_(0)、高于T_(1),且差异均有统计学意义(P<0.05);观察组T_(1)、T_(2)时间点的心率、平均动脉压均高于对照组(P<0.05)。观察组新生儿出生后1 min、5 min的Apgar评分均高于对照组(P<0.05)。观察组新生儿二氧化碳分压(PCO_(2))低于对照组(P<0.05),氧分压(PO_(2))高于对照组(P<0.05)。两组产妇麻醉药物相关总不良反应发生率及母体不良事件发生率比较,差异无统计学意义(P>0.05),观察组新生儿不良事件发生率低于对照组(P<0.05)。【结论】CSEA、全麻在妊高征产妇剖宫产手术中各有利弊,全麻对产妇血流动力学影响较小,麻醉起效快,但不利于新生儿预后情况;与全麻相比,CSEA可更有效保障新生儿安全。

【Objective】To investigate the impact of combined spinal-epidural anesthesia(CSEA)and general anesthesia on adverse events during cesarean section and maternal-infant outcomes in pregnant women with hypertension.【Methods】A total of 84 pregnant women with pregnancy induced hypertension(preeclampsia)admitted to our hospital were randomly divided into two groups,with 42 cases in each group.All women underwent cesarean section,with the control group receiving general anesthesia and the observation group receiving CSEA.The anesthesia conditions and perioperative hemodynamic changes were compared between the two groups.Apgar scores at 1 minute and 5 minutes after birth and umbilical artery blood gas parameters of newborns were compared.The occurrence of anesthesia-related adverse events and maternal-infant outcomes during hospitalization were compared between the two groups.【Results】The onset time of anesthesia and the time from anesthesia initiation to delivery were longer in the observation group than in the control group(P<0.05).At the time of fetal delivery(T_(1)),both groups showed a significant decrease in heart rate and mean arterial pressure compared to before anesthesia(T_(0))(P<0.05).At the end of surgery(T_(2)),heart rate in both groups increased compared to T_(0)and T_(1),while mean arterial pressure was lower than T_(0)and higher than T_(1),with statistically significant differences(P<0.05).The heart rate and mean arterial pressure at T_(1)and T_(2)were higher in the observation group than in the control group(P<0.05).Apgar scores at 1 minute and 5 minutes after birth in the observation group were higher than that in the control group(P<0.05).The observation group had lower carbon dioxide partial pressure(PCO_(2))and higher oxygen partial pressure(PO_(2))in newborns compared to the control group(P<0.05).There was no statistically significant difference in the occurrence rate of overall anesthesia-related adverse reactions and maternal adverse events between the two groups(P>0.05),while the occurrence rate of adverse events in newborns was lower in the observation group than in the control group(P<0.05).【Conclusion】Both CSEA and general anesthesia have advantages and disadvantages in cesarean section for pregnant women with preeclampsia due to hypertension.General anesthesia has minimal impact on maternal hemodynamics and provides rapid onset of anesthesia but may adversely affect neonatal outcomes.Compared to general anesthesia,CSEA can more effectively ensure the safety of newborns.