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目的观察腰麻—硬膜外联合阻滞(CSEA)和单纯腰麻(SA),行剖宫产术其临床麻醉效果及对母体循环功能与新生儿的影响。方法将156例急症剖宫产ASA I~Ⅱ级足月产妇,分成CSEA和SA两组,每组78例,术前测血压、心率、氧饱和度作为基础对照值。记录两组麻醉起效时间,阻滞平面上界和手术结束时阻滞平面,手术开始时间,自切皮至切子宫至胎儿取出时间,新生儿Apgar评分,记录胎儿取出前每分钟及胎儿取出后每5分钟测得的母体动脉压、心率、氧饱和度、术中出血量和具体处理情况。结果麻醉开始至术始及切皮至胎儿取出时间相比,SA组均明显短于CSEA组(P<0.01),两组出血量、麻醉效果比较差异无统计学意义,但SA组血压下降明显早于CSEA组(P<0.05)。两组平均麻黄碱用量、心率减慢平均阿托品用量比较差异无统计学意义,新生儿1和5m in Apgar评分及2、24h神经行为评分差异无统计学意义,术后头痛SA组高于CSEA组。术后CSEA组产妇要求镇痛的时间明显迟于SA组。结论CSEA及SA两种麻醉方法均能为剖宫产术提供优良的麻醉效果,对母体循环功能及新生儿无显著影响,相比之下CSEA组麻醉对产妇更有利。
Objective To observe the effects of cesarean section on spinal anesthesia and maternal circulatory function and newborn with spinal anesthesia - epidural block (CSEA) and simple spinal anesthesia (SA). Methods A total of 156 acute full-term cesarean section ASA class I ~ II full-term pregnant women were divided into CSEA and SA groups, 78 cases in each group. Preoperative blood pressure, heart rate and oxygen saturation were used as the baseline control. The onset time of anesthesia, block plane upper limit and the blockage plane at the end of surgery, the time of operation, the time from skin incision to the uterus to fetus removal, Apgar score of neonates were recorded, and the fetus was taken out every minute before fetal removal Measured after 5 minutes of maternal arterial pressure, heart rate, oxygen saturation, intraoperative blood loss and specific treatment. Results Compared with CSEA group, the SA group was significantly shorter than the CSEA group (P <0.01). There was no significant difference between the two groups in blood loss and anesthesia, but the blood pressure in SA group decreased significantly Earlier than CSEA group (P <0.05). There was no significant difference in the average amount of ephedrine and the slow average heart rate atropine consumption between the two groups. Neonatal 1 and 5m in Apgar scores and 2,24h neurological behavioral scores had no statistical significance. After SAH, SA group was higher than CSEA group . Postoperative CSEA maternal pain relief time was significantly later than the SA group. Conclusion Both CSEA and SA anesthesia can provide excellent anesthesia for cesarean section with no significant effect on maternal circulatory function and newborns, compared with CSEA group.