腰麻 硬外阻滞行剖宫产术中疼痛的特点分析

Characeristics and Management on Pain during Combined Spinal Epidural Anesthesia for Cesarean Delivery

目的 探讨腰麻 -硬外联合阻滞行剖宫产术疼痛的特点和处理。 方法 70例剖宫产采用CSEA ,根据麻醉平面不同分为 3组。A组麻醉平面T3～ 5,B组麻醉平面T6～ 7,C组麻醉平面T8。观察各组术中不适及处理效果。 结果 术中疼痛反应总数A、B、C三组比较有明显差异 (P <0 .0 5 ) ,A、B组剑突下疼痛例数有显著差异 (P <0 .0 5 )。A、B组疼痛部位为下腹部或剑突下 ,疼痛为持续性 ,手术操作停止后仍无减轻。剑突下疼痛给予阿托品后症状减轻或消失 ,下腹部疼痛需硬膜外给予局麻药方可达到满意镇痛效果 ;C组疼痛部位在下腹部 ,刺激停止后绝大多数疼痛可消失。 结论 CSEA行剖宫产术中疼痛特点随着麻醉平面的改变而不同。术中应根据疼痛发生的原因采取不同的治疗手段。

Objective To investigate the characteristics and treatment of pain during combined spinal and epidural anesthesia.Methods 70 cases of cesarean deliveries used CSEA were collected.According to different level of anesthesia,they were divided into three groups.A group:level of anesthesia T 3～5 ,B group:level of anesthesia T 6～7 ,C group:level of anesthesia T 8.Observing the discomfort and treatment effects during operation of each group.Results There are significant differences among A,B,and C group in total number of reaction of pain(P<0.05),and there are significant differences among A and B group in case number of pain below xiphoid(P<0.05).The pain in A and B group occur below xiphoid or hypogastrium,the pain is durative,and still not alleviative after the stop of operation.The symptom of pain below xiphoid can alleviate or disappear after dealing with atroping.It only can obtain satisfied effect after dealing with epidural paredtic prescription for the pain in hypogastrium.The pain in C group occurs in hypogastrium,and most pain can disappear after the stop of stimulation.Conclusions The characteristics on pain during CSEA for cesarean delivery are different with the changes of level of anesthesia.It should adopt different treatment according to the cause of pain during operation.