腰麻-硬膜外联合麻醉对剖宫产母婴肾素-血管紧张素-醛固酮系统的影响

Effect of combined spinal-epidural anesthesia for caesarean section on maternal and neonatal renninangiotensin-aldosterone system

目的 研究腰麻-硬膜外联合麻醉(CSEA)对剖宫产母婴肾素-血管紧张素-醛固酮系统(RAAS)的影响。方法 将60例ASA I级行择期剖宫产的健康产妇随机分为硬膜外麻醉组(EA组,n=30)和CSEA组(n=30)。分别于注射局麻药前(T0)、切皮后即刻(T1)、胎儿娩出后即刻(T2)、术毕即刻(T1)和术后24 h(T4)取母体静脉血和胎儿娩出后胎儿脐动、静脉血测定血清肾素活性(PRA)、血管紧张素II(AT-Ⅱ)和醛固酮(ALD)浓度;评定麻醉效果,记录痛觉阻滞平面达T2水平的时间,注射局麻药至胎儿娩出时间(I-DI)及新生儿娩出1 min、5 min的Apgar评分。结果 两组术中SP、DP、HR、SpO2的变化及新生儿娩出1 min、5 min的Apgar评分差异无显著性(P>0.05)。同EA组相比,CSEA组麻醉起效时间明显缩短,I-DI亦明显缩短(P<0.01)。两组母体于T1、T2、T4的PRA、AT-Ⅱ、ALD值均比T0、T3值明显降低(P<0.01),胎儿脐动、静脉血中三者值差异不明显,但明显低于母体T0、T3值(P<0.01)。结论CSEA用于剖宫产手术时,只要运用得当,不会对母婴RAAS产生不良影响。

Objective To assess the effect of combined spinal-epidural anesthesia (CSEA) for caesarean section on maternal and neonatal rennin-angiotensin-aldosterone system (RAAS) . Methods Sixty ASA I primiparae aged 22-29 yr, weighing 46-83 kg, scheduled for elective caesarean section were randomized into epidural anesthesia group (EA, n = 30) and combined spinal-epidural anesthesia group (CSEA, n = 30) . All patients were premedicated with intramuscular atropine 0.5 mg and phenolbarbital 100 mg. In CSEA group a 26G/ 16G single use spinal/epidural needle (B-D) was used. Spinal and/or epidural anesthesia was performed at L2-3 interspace and a catheter was threaded into the epidural space cephalad for 3-5 cm in both groups. In EA group a loading dose of 12-16 ml 2% lidocaine was given and an additional 6-8 ml 2% lidocaine was injected when anesthesia became inadequate during the operation. In CSEA group 2.0-2.5 ml hyperbaric 0.5% bupivacaine (10-12.5 mg) was given intrathecally and 2% lidocaine 5 ml was given through epidural catheter when analgesia was inadequate during operation. The level of block was T, . The blood samples were taken from maternal peripheral vein before local anesthetic was given (T0), immediately after skin incision (T1 ) , at delivery (T2) , at the end of surgery (T3) and 24h after operation (T4) and also from umbilical artery and vein for determination of plasma rennin activity (PRA) and plasma concentration of angiotensin (AT- II ) and aldosterone (ALD). The duration between the induction of spinal or epidural block and delivery (I-DI) and Apgar score of the neonate at 1 and 5 min after birth were recorded. Results There was no significantly different in maternal BP, HR, SpO2 and Apgar scores of the neonates between the two groups ( P > 0.05). In CSEA group the block is faster in onset and the I-DI was significantly shorter ( P < 0.01) . Maternal plasma PRA, AT- II and ALD at T1 , T2 and T4 were significantly lower than those at T0 and T3 in both groups. There was no significant difference in umbilical arterial and venous plasma PRA, AT- II and ALD between the two groups. Conclusion CSEA for caesarean section has no adverse effects on maternal and neonatal RAAS.