联合椎管内麻醉下行剖宫产的临床研究

Clinical study on combined spinal epidural anesthesia for cesarean section

目的 比较并评价联合椎管内麻醉 (CSEA)和硬膜外麻醉 (EA)用于剖宫产的临床效果。方法 将 68例择期健康足月妊娠产妇随机分为CSEA组和EA组。观察局部麻醉药用量、感觉阻滞 (针刺法 )、运动阻滞 (改良Bromage评分 )、术中疼痛 (VAS评分 )、新生儿状态 (Apgar评分 )、镇痛和腹壁肌肉松弛质量、术中低血压及其他不良反应。结果 CSEA组局麻药用量较EA组小 (P <0 .0 1) ;感觉阻滞平面达T6及最高平面的时间短于EA组 (P <0 .0 5 ) ;镇痛满意率CSEA组为10 0 % ,EA组为 76% ;运动阻滞评分CSEA组高于EA组 (P <0 .0 1) ;腹肌松弛满意率CSEA组 94% ,EA组 5 3 % (P <0 .0 1) ;两组新生儿Apgar评分无差异 ;术中收缩压 (SBP)下降至最低值的时间CSEA组短于EA组 (P <0 .0 5 ) ,SBP下降的幅度两组之间无显著差异。两组均无术后头痛。EA组寒颤、恶心呕吐发生率较CSEA组高 ,但两组比较并无差异。结论 CSEA效果更确切 ,不良反应少 ,是剖宫产较为理想的麻醉选择。

Objective To compare and evaluate the clinical efficacy of combined spinal epidural anesthesia(CSEA) and epidural anesthesia (EA) in patients undergoing cesarean section.Methods Sixty eight pregnant women at full term were randomly divided into CSEA group and EA group.The dosage of local anesthetic agents,sensory block (pinprick),motor block (modified Bromage scale),intraoperative pain (VAS score),neonatal state (Apgar score),quality of analgesia and abdominal wall relaxation were assessed.Intraoperative hypotension and other adverse event were observed.Results The dosage of local anesthetic agents was smaller in CSEA group than that in EA group( P <0.01).The sensory block time to T 6 and the highest level were shorter in CSEA group.Zero pain score in CSEA group was 100% but 76% in EA group ( P <0.05).Abdominal wall relaxation and motor block were much better in CSEA group ( P <0.01).Apgar score for neonates showed no significant difference between two groups.Although the incidence of hypotension had no difference between two groups,but a significantly faster hypotension was found in CSEA group ( P <0.05).No one in the either group had postdural puncture headache (PDPH).More women in EA group had shivering,nausea and vomiting but there were no obvious statastic differences between two groups.Conclusion CSEA has greater efficacy and fewer side effects with a good foreground for clinical application in cesarean sections.