经L_(2~3)间隙腰硬联合麻醉对剖宫产产妇血流动力学和麻醉效果的影响

Influence of combined spinal-epidural anesthesia through L_(2-3) gap on hemodynamics and anesthetic effect in women undergoing cesarean section

目的探究经L_(2~3)间隙腰硬联合麻醉对剖宫产产妇血流动力学和麻醉效果的影响。方法选取2020年1月至2022年1月赣南医学院第二附属医院麻醉科收治的80例剖宫产产妇作为研究对象,按照随机数字表法分为观察组与对照组,各40例。对照组经L_(3~4)间隙腰硬联合麻醉,观察组经L_(2~3)间隙腰硬联合麻醉,比较两组产妇的麻醉效果、血流动力学、胎儿娩出时间和新生儿Apgar评分和不良反应情况。结果观察组麻醉总有效率为97.50%,高于对照组的80.00%,差异有统计学意义(P<0.05)。手术结束后,观察组平均动脉压(mean arterial pressure,MAP)水平低于对照组,心输出量(cardiac output,CO)和心率(heartrate,HR)水平均高于对照组,差异有统计学意义(P<0.05)。观察组胎儿娩出时间短于对照组,差异有统计学意义(P<0.05)。两组新生儿Apgar评分组间、时间及交互比较差异有统计学意义(P<0.05);观察组出生1、5、10min的新生儿Apgar评分均高于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率为5.00%,低于对照组的25.00%,差异有统计学意义(P<0.05)。结论经L_(2~3)间隙腰硬联合麻醉对剖宫产产妇麻醉效果良好,对血流动力学指标的影响较小,值得临床推广应用。

Objective To investigate the influence of combined spinal-epidural anesthesia through L_(2-3) gap on hemodynamics and anesthetic effect in women undergoing cesarean section.Methods A total of 80 women who underwent cesarean section in the department of anesthesiology,the Second Hospital of Gannan Medical University from January 2020 to January 2022 were selected as the research subjects,and they were divided into the observation group and the control group according to random number table method,with 40 cases in each group.The control group received com-bined spinal-epidural anesthesia through L_(3-4) gap,while the observation group received combined spinal-epidural anesthesia through the L_(2-3) gap.An-esthesia effects,hemodynamics,delivery time of the baby,neonatal Apgar score and adverse reactions were compared between the two groups.Re-sults The total response rate in the observation group was 97.50%,which was higher than 80.00%in the control group,the difference was statistical-ly significant(P<0.05).After operation,the mean arterial pressure(MAP)in the observation group was lower than that in the control group,and the cardiac output(CO)and heart rate(HR)were higher than those in the control group,the differences were statistically significant(P<0.05).The de-livery time of the baby in the observation group was shorter than that in the control group,the difference was statistically significant(P<0.05).There were statistically significant differences in neonatal Apgar scores in terms of groups,time points and interaction(P<0.05);the neonatal Apgar scores at 1,5 and 10 min after birth in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was 5.00%,which was lower than 25.00%in the control group,the difference was statistically significant(P<0.05).Conclusion Combined spinal-epidural anesthesia through L_(2-3) gap has good anesthetic effect on cesarean section,and little influence on hemodynamic indexes,which is worthy of clinical promotion and application.