程序化间歇硬膜外麻醉在妊娠期高血压疾病剖宫产术中的应用

Application value of programmed intermittent epidural anesthesia in caesarean section for women with gestational hypertension

目的 探讨程序化间歇硬膜外麻醉在妊娠期高血压疾病剖宫产术中的应用价值。方法 于2023年1~12月期间在南阳市中心医院收集病例展开研究,将100例择期拟行剖宫产术的妊娠期高血压疾病产妇采用随机数表法分为间歇组和连续组各50例。连续组产妇采用连续性硬膜外麻醉,间歇组产妇采用程序化间歇硬膜外麻醉。比较两组产妇的麻醉效果和不同时间的平均动脉压(MAP)、心率(HR)以及术后12 h、24 h、36 h的视觉模拟评分法(VAS)评分和双下肢Bromage评分;同时比较两组新生儿的1 min阿氏评分和5 min阿氏评分。结果 间歇组产妇的感觉阻滞起效时间和运动阻滞起效时间明显短于连续组,而感觉阻滞持续时间和运动阻滞持续时间则明显长于连续组,差异均有统计学意义(P<0.05);两组产妇的麻醉诱导前(T0)的MAP、HR比较差异均无统计学意义(P>0.05);间歇组产妇的切皮时(T1)、胎儿娩出时(T2)、胎儿娩出后5 min (T3)时的MAP明显高于连续组,而HR也明显高于连续组,差异均有统计学意义(P<0.05);间歇组产妇术后12 h、24 h、36 h的VAS评分分别为(1.41±0.17)分、(1.25±0.12)分、(1.05±0.08)分,明显低于连续组的(2.06±0.21)分、(1.87±0.19)分、(1.64±0.14)分,差异均有统计学意义(P<0.05);间歇组产妇术后12 h、24 h、36 h的双下肢Bromage评分分别为(1.23±0.12)分、(1.08±0.09)分、(0.84±0.07)分,明显低于连续组的(1.54±0.15)分、(1.36±0.11)分、(1.19±0.10)分,差异均有统计学意义(P<0.05);间隙组新生儿的1 min阿氏评分和5 min阿氏评分分别为(9.74±0.11)分、(9.84±0.07)分,与连续组的(9.77±0.09)分、(9.86±0.05)分比较差异均无统计学意义(P>0.05)。结论 妊娠期高血压疾病产妇剖宫产术中采用程序化间歇硬膜外麻醉的麻醉效果和镇痛效果确切,血流动力学稳定性好,利于术后早期恢复,且不会对新生儿安全性产生影响。

Objective To analyze the application value of programmed intermittent epidural anesthesia in cesarean section for women with gestational hypertension.Methods One hundred women with gestational hypertension admitted in Nanyang Central Hospital from January 2023 to December 2023 and scheduled for cesarean section were divided into an intermittent group(n=50)and a continuous group(n=50)using random number table method.The women in the continuous group received continuous epidural anesthesia,and those in the intermittent group received programmed intermittent epidural anesthesia.The anesthetic effect,mean arterial pressure(MAP),and heart rate(HR)of the two groups were compared.Visual Analogue Score(VAS)and Bromage score of both lower limbs were compared between the two groups at 12 h,24 h,and 36 h after surgery.The 1-min Apgar score and 5-min Apgar score were compared between the two groups.Results The onset time of sensory block and motor block in the intermittent group were significantly shorter than those in the continuous group(P<0.05),and the duration of sensory block and motor block were significantly longer than those of continuous group(P<0.05).There was no significant difference in MAP and HR between intermittent group and continuous group before anesthesia(T0),P>0.05.The MAP at incision(T1),delivery(T2),and 5 min after delivery(T3)in the intermittent group were significantly higher than those in the continuous group,while HR at T1,T2 and T3 in the intermittent group were significantly higher than those in the continuous group(P<0.05).The VAS scores at 12 h,24 h and 36 h after surgery were(1.41±0.17)points,(1.25±0.12)points,and(1.05±0.08)points in the intermittent group,respectively,significantly lower than(2.06±0.21)points,(1.87±0.19)points,and(1.64±0.14)points in the continuous group(P<0.05).The Bromage scores of both lower extremities in the intermittent group were(1.23±0.12)points,(1.08±0.09)points,and(0.84±0.07)points at 12 h,24 h,and 36 h after surgery,significantly lower than(1.54±0.15)points,(1.36±0.11)points,and(1.19±0.10)points in the continuous group(P<0.05).The 1-min Apgar score and 5-min Apgar score of newborns in the intermittent group were(9.74±0.11)points and(9.84±0.07)points,respectively,which showed no statistically significant difference with(9.77±0.09)points and(9.86±0.05)points in the continuous group(P>0.05).Conclusion The use of programmed intermittent epidural anesthesia during cesarean section for for women with gesta-tional hypertension has definite anesthetic and analgesic effects, as well as good hemodynamic stability, which is condu-cive to early postoperative recovery and does not affect the safety of newborns.