硬膜外和脊麻在无痛分娩失败改剖宫产术中的应用效果观察

Effect Observation of Epidural Anesthesia and Spinal Anesthesia in Cesarean Section after Failed Painless Labor

目的比较硬膜外麻醉和脊麻在无痛分娩失败改剖宫产术的应用效果。方法选择200例无痛分娩失败,硬膜外导管均固定良好的患者。随机分为两组,分别为治疗组100例,经硬膜外推注碳酸利多卡因。对照组100例,重新穿刺用布比卡因做脊麻。结果治疗组运动神经阻滞起效时间明显长于对照组,但治疗组自入手术室到开腹的时间明显少于对照组,两组差异均有统计学意义(P<0.05)。两组新生儿Apgar评分比较,差异无统计学意义(P>0.05)。但是对照组脊麻穿刺失败率高达35%,远高于非无痛分娩剖宫产脊麻的穿刺失败率。结论无痛分娩失败患者如果硬膜外导管没有脱落,不要重新穿刺选择脊麻,直接硬膜外导管给药即可。如果硬膜外导管脱落,可以选择硬腰联合麻醉,如果脊麻不成功,不要反复穿刺,耽误时间,置管选择硬膜外麻醉即可。

Objective To compare the effects between epidural anesthesia and spinal anesthesia in cesarean section after failed painless labor. Methods Two hundred cases of failed painless labor were selected,with good fixation of epidural catheter. They were randomized into two groups. In the treatment group,100 cases,epidural injection with lidocaine carbonate was used. In the control group,100 cases,spinal puncture was done for anesthesia with bupivacaine. Results In the treatment group,the onset time of motor nerve block was apparently longer than that in the control group. But,in the treatment group,the time from entering operating room to laparotomy was apparently shorter than that in the control group. The differences were significant statistically between the two groups( P < 0. 05). The newborn Apgar score was not different significantly between the two groups( P > 0. 05). In the control group,the failure rate of puncture anesthesia was up to 35%,quite higher than that with cesarean section without painless labor. Conclusion The puncture for spinal anesthesia is not recommended in the patients of failed painless labor if the epidural catheter is not dropped. Epidural injection is quite applicable. If the epidural catheter is dropped,spinal and epidural anesthesia is applicable. If the spinal anesthesia is failed,the repeated puncture is not recommended. The epidural anesthesia should be used to save time.