小剂量腰麻联合硬膜外阻滞麻醉对剖宫产孕妇术中血压、循环系统的影响

Effect of low-dose Lumbar Anesthesia Combined with Epidural Block on Blood Pressure and Circulatory System of Pregnant Women in Cesarean Section

目的探讨小剂量腰麻联合硬膜外阻滞麻醉对剖宫产孕妇术中血压及循环系统的影响。方法选择2013年2月～2015年6月于我院择期行剖宫产的86例产妇作为研究对象,按随机数字表法分为对照组、观察组,观察组给予小剂量腰麻联合硬膜外阻滞,对照组予单纯硬膜外麻醉,记录两组麻醉前(T0)、麻醉后仰卧(T1)、麻醉5 min(T2)、麻醉10 min(T3)及胎儿娩出时(T4)产妇心率(HR)、收缩压(SBP)、舒张压(DBP)的变化情况,采用改良下肢运动阻滞评分法(Bromage)评定两组下肢运动阻滞情况,记录麻醉至手术开始时间、总手术时间、麻黄碱用量,统计不良反应发生情况,评定阻滞效果。结果①与T0点比较,两组T1、T2、T3、T4点HR均上升,对照组上升幅度高于观察组,仅T2点对比差异无统计学意义(P>0.05),两组SBP、DBP均降低(P<0.05),观察组降低幅度均低于对照组,两组仅T1点DBP对比差异无统计学意义(P>0.05),其余各时间点SBP、DBP对比差异均有统计学意义(P<0.05);②两组麻醉至手术时间、手术时间对比差异无统计学意义(P>0.05),观察组Bromage评分高于对照组,麻黄碱用量低于对照组(P<0.05);③观察组阻滞优良率高于对照组(P<0.05);④观察组各不良反应发生率均低于对照组,但仅低血压发生率对比差异有统计学意义(P<0.05)。结论小剂量布比卡因(1mL)腰麻联合硬膜外阻滞麻醉用于剖宫产术中,麻醉效果好,阻滞完善,患者血压、心率变化幅度小,安全性高。

Objective To investigate the effect of low-dose lumbar anesthesia combined with epidural block on blood pressure and circulation system of pregnant women in cesarean section.Methods 86 pregnant women who underwent cesarean section in our hospital between February 2013 and June 2015 were selected as the study subjects.According to the random number table method,they were divided into the control group and observation group.The observation group was given low-dose lumbar anesthesia combined with epidural block,while the control group was given simple epidural anesthesia.The changes of heart rate(HR),systolic blood pressure(SBP)and diastolic blood pressure(DBP)of pregnant women in the two groups before anesthesia(T0),when supine after anesthesia(T1),5 min of anesthesia(T2),10 min of anesthesia(T3)and delivery of baby(T4)were recorded.The status of lower limb motor block in the two groups was evaluated by modified lower limb motor block score(Bromage).The time from anesthesia to the start of operation,total operative time and the dosage of ephedrine were recorded.The incidence adverse reactions was statistically analyzed and the effect of block was evaluated.Results①Compared with T0,at T1,T2,T3 and T4,HR all increased,and the increasing range in control group was greater than observation group but there only was significant difference at T2(P>0.05).SBP and DBP of the two groups were decreased(P<0.05),and the decreasing range in the observation group was lower than the control group but there only was significant difference of DBP between the two groups at T1(P>0.05).The differences of DBP and SBP at other time points were statistically significant(P<0.05);②The differences in time from anesthesia to the start of operation and operative time between the two groups were not significant(P>0.05).Bromage score of observation group was higher than that of the control group,and the dosage of ephedrine was lower than control group(P<0.05);③The good and excellent rate of block in observation group was higher than that in control group(P<0.05);④The incidence of adverse reactions in the observation group was significantly lower than that in control group,but only the difference in the incidence of hypotension was significant(P<0.05).Conclusion The application of low-dose of bupivacaine(1 mL)lumbar anesthesia combined with epidural block in cesarean section,the anesthesia effect is good,with good block effect.The changes of patient’s blood pressure and heart rate are small,and safety is high.