不同体位腰硬联合麻醉对剖宫产产妇麻醉质量及新生儿的影响

Effects of the spinal-epidural anesthesia of women with different positions during cesarean section on their anesthesia quality and neonatal outcomes

目的:探讨不同体位腰硬联合麻醉对剖宫产产妇麻醉质量及新生儿结局的影响。方法:选取2023年1-12月在江南大学附属医院择期行腰硬联合麻醉剖宫产产妇110例,根据腰硬联合麻醉不同穿刺体位分为坐位组(55例)和侧卧组(55例),观察记录两组麻醉前后的血流动力学指标、麻醉质量及新生儿结局情况。结果:坐位组麻醉后HR(89.4±6.9次/min)和MAP(74.3±5.5 mmHg)变化优于侧卧组(94.3±7.5次/min、69.0±6.4 mmHg),运动阻滞起效时间(3.17±0.81 min)、感觉阻滞起效时间(3.62±0.74 min)、Bromage最大运动阻滞程度时间(12.78±1.92 min)和达到最高麻醉平面时间(10.65±1.38 min)均短于侧卧组(4.39±0.93 min、5.08±0.82 min、14.39±2.13 min、12.46±1.59 min),新生儿脐动脉血pH值(7.35±0.08)和BE值(-1.89±0.62)均高于侧卧组(7.28±0.14、-2.45±0.78)(均P<0.05),两组新生儿胎心异常、胎儿窘迫、新生儿窒息以及新生儿出生Apgar评分均无差异(P>0.05)。结论:剖宫产术采用坐位下腰硬联合麻醉对产妇血流动力学及麻醉质量好于侧卧组,且对新生儿结局影响更小。

Objective:To explore the effects of the spinal-epidural anesthesia of women with different positions during cesarean section on their anesthesia quality and neonatal outcome.Methods:A total of 110pregnant women who wanted spinal-epidural anesthesia during cesarean section in the affiliated hospital of Jiangnan university were selected as the study subjects from January to December 2023.These women were divided into group A(55 cases with sitting for spinal-epidural anesthesia)and group B(55 cases with lateral decubitus for spinal-epidural anesthesia).The hemodynamic indicators before and after anesthesia,the anesthesia quality and the neonatal outcomes of the women in the two groups were observed and recorded.Results:The changes of the values of HR(89.4±6.9beats/min)and MAP(74.3±5.5mmHg)after anesthesia of the women in group A were significantly better than those(94.3±7.5 beats/min and 69.0±6.4mmHg)of the women in group B.The onset time of motor block(3.17±0.81min),the onset time of sensory block(3.62±0.74min),the time of reaching maximum Bromage motor block(12.78±1.92min)and the time of reaching the highest level of anesthesia(10.65±1.38min)of the women in group A were significantly shorter than those(4.39±0.93min,5.08±0.82min,14.39±2.13min and 12.46±1.59min)of the women in group B.The values of umbilical artery blood pH(7.35±0.08)and BE(-1.89±0.62)of the women in group A were significantly higher than those(7.28±0.14 and-2.45±0.78)of the women in group B(all P<0.05).There were no significant differences in the fetal heart rate,the rates of the fetal distress and neonatal asphyxia,and the neonatal Apgar score of the women between the two groups(P>0.05).Conclusion:The spinal-epidural anesthesia of the women in the sitting position at anesthesia during cesarean section has better hemodynamic indicators and anesthesia quality than those of the women in the lateral decubitus position at anesthesia,and which has less impact on the neonatal outcomes of the women.