超声引导定位下椎管内麻醉在肥胖妊高症患者剖宫产中的应用效果

Clinical effect of ultrasound-guided spinal anesthesia on cesarean section in pregnancy induced hypertension with obese

目的探讨肥胖妊高症患者剖宫产中应用超声引导定位下椎管内麻醉的临床效果。方法纳入保定市妇幼保健院2020年1月至2022年7月收治的肥胖妊高症患者80例为研究对象,随机分2组,每组40例。研究组实施超声引导定位下椎管内麻醉,对照组采用传统触诊定位下椎管内麻醉,比较2组穿刺情况、麻醉效果、生命体征相关指标、新生儿Apgar评分和并发症。结果研究组麻醉前准备时间、麻醉穿刺时间和麻醉起效时间均短于对照组,穿刺次数少于对照组(P<0.05)。研究组麻醉效果优于对照组(P<0.05)。麻醉用药后10 min,研究组心率、收缩压和舒张压均低于对照组,研究组生命体征较对照组更稳(P<0.05)。研究组新生儿娩出后1 min、5 min和10 min的Apgar评分均高于对照组(P<0.05)。研究组神经刺激、硬膜外置管出血等并发症发生率为2.50%,低于对照组的20.00%(P<0.05)。结论肥胖妊高症患者剖宫产中应用超声引导定位下椎管内麻醉能提高麻醉穿刺成功率,降低患者应激反应,减少并发症,提高新生儿Apgar评分和麻醉效果。

Objective To explore the clinical effect of ultrasound-guided spinal anesthesia on cesarean section in pregnancy induced hypertension(PIH)with obese.Methods A total of 80 PIH patients with obese admitted to Baoding Maternal and Child Health Hospital from January 2020 to July 2022 were randomly assigned to the research group(n=40)and the control group(n=40),in which they received ultrasound-guided spinal anesthesia and traditional landmark-guided spinal anesthesia,respectively.The puncture situation,anesthesia effects,vital signs related indicators,neonatal Apgar scores,complication were included as comparators.Results Patients in the research group presented significantly shorter duration of anesthesia preparation,anesthesia puncture,anesthesia onset,significantly less puncture times,significantly better anesthesia effects than those of the control group(P<0.05).After 10 minutes of anesthesia,patients in the research group presented significantly lower heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),significantly stable of vital signs than those of the control group(P<0.05).The neonatal Apgar scores in the research group at 1 minute,5 minutes,and 10 minutes after birth were significantly higher than those in the control group(P<0.05).The incidence of complications(nerve stimulation,epidural hemorrhage)in the research group was significantly lower than that of the control group(2.50%vs 20.00%,P<0.05,respectively).Conclusion Ultrasound-guided spinal anesthesia in cesarean section in PIH patients with obese can improve the success rate of anesthesia puncture,reduce stress response and complications,and improve the neonatal Apgar scores and anesthesia effect.