腰麻-硬膜外联合麻醉用于剖宫产术的评价

Evaluation of Combined Spinal-epidural Anaesthesia for Cesarean Section

目的 评价腰麻 -硬膜外联合麻醉 (CSEA)用于剖宫产手术的麻醉效果以及对母婴安全性的影响。方法 选择母婴健康拟行剖宫产术的孕妇 44例 ,ASAⅠ～Ⅱ级 ,随机分成腰麻 -硬膜外联合麻醉组 (CSEA组 )和连硬外阻滞组 (EA组 ) ,比较两组麻醉起效时间、肌松质量、麻醉前、后血流动力学变化以及不良反应。结果 CSEA组感觉和运动阻滞起效时间以及达到最大感觉和运动阻滞的时间明显短于EA组 ,且CSEA组肌松质量明显优于EA组 ,CSEA组麻醉后 1、3、5min血压低于麻醉前 ,心率较麻醉前增快 ,其他各时间点血流动力学指标与麻醉前比较无统计学差异 ,EA组麻醉前后血流动力学指标无统计学差异 ,两组新生儿Apgar评分无统计学差异 ,EA组术中有 1 1例出现寒战 ,明显高于CSEA组 ,术中及术后其他不良反应两组无统计学差异。结论 CSEA可替代EA用于剖宫产手术。

Objective To evaluate the effects of combined spinal-epidural anaesthesia(CSEA) and the influence of it on both mother and fetus in cesarean section. Methods Forty-four ASAⅠ～Ⅱ parturients undergoing cesarean section were randomly allocated to one of two groups of twenty-two each: CSEA group and EA group. The onset times of anaesthesia and the quality of motor block, blood pressure and heart rates before anaesthesia and at 1,3,5,10,15,25 min after anaesthesia, intra- and postoperative complications and side effects, Apgar scores of neonate were recorded and compared between groups. Results Of the two groups ,CSEA group was associated with earlier onset times of sensory and motor blockade( P <0.01) and more intensive motor block( P <0.01). Compared with baseline, blood pressure decreased( P <0.01)and heart rate increased( P <0.05)at 1,3,5 min after anaesthesia and there were no significant difference in parameters of hemodynamics at other times after anaesthesia in CSEA group. The hemodynamics was no significant change before and after anaesthesia in EA group. There was a significantly higher incidence of shivering(11of22)in EA group than that in CSEA group( P <0.01).There were no significant difference in other intra- and postoperative complications and side effects between groups, and the neonatal Apgar scores were excellent in two groups. Conclusions CSEA can replace EA for cesarean section.