腰硬联合麻醉剖宫产术中合理麻醉平面的探讨  

An Investigation of Rational Anesthesia Levels in Parturients under CSEA

作　　者：朱向晖[1] 

机构地区：[1]菏泽医学专科学校附属菏泽市立医院,山东菏泽274031

出　　处：《菏泽医学专科学校学报》2006年第1期6-8,共3页Journal of Heze Medical College

摘　　要：目的探讨CSEA剖宫产术中不同麻醉平面对麻醉效果的影响。方法选择ASAⅠ～Ⅱ级、身高155～165cm的产妇100例，在CSEA下行剖宫产术，调整麻醉平面上界，按照固定的最高平面分三组：Ⅰ组，T4～5、Ⅱ组T6～8、Ⅲ组T9～10。观察记录各组麻醉前后的血压（MAP）、心率（HR）及脉搏氧饱和度（SPO2）和呼吸困难情况，观察术中恶心呕吐、寒颤及腹部牵拉不适等不良反应的发生情况，记录新生儿娩出1分钟和5分钟时的Apgar评分及术中出血量。结果（1）BP、HR与麻醉前后：Ⅰ组差异有显著性（P〈0．05），且伴有较为明显的SPO2的下降（P〈0、05），Ⅱ、Ⅲ组无差异。（2）自述呼吸困难工组明显高于Ⅱ、Ⅲ两组（P〈0．01）。（3）恶心呕吐的发生率Ⅱ组明显要低于Ⅰ、Ⅲ两组（P〈0．05）。（4）寒颤的发生率Ⅰ组要高于Ⅱ、Ⅲ两组（P〈0．01）。（5）腹部牵拉不适的发生率Ⅲ组明显要高于Ⅰ、Ⅱ组（P〈0.01）。（6）三组新生儿1分钟、5分钟Apgar评分均在8分以上。（7）术中出血量Ⅰ组多于Ⅱ、Ⅲ两组（P〈0．05）。结论在CSEA剖宫产手术中，调整麻醉平面上界在Ⅰ组（T6～8）水平时，麻醉过程维持平稳、效果理想，不良反应少。Objective To investigate the effect of divers anesthosia levels on anesthesia effect and sideeffect in Parturients under CSEA. Methods One hundred ASA class Ⅰ -Ⅱ , lying - in women scheduled for Parturients under CSEA , were＇ divided into three groups according to the crowning anesthesia level of thorax ： group Ⅰ T 4 - 5, group Ⅱ T6-8, group ⅢT9-10. The Needing pressure （ MAP） , heart rate （HR） , pluse oxygen saturation （SpO2） were monitored and recorded before and after anesthesia , decompmsation and side effect of nause , vomiting, ague and abdominal pulling dragging reflex were observed and recorded , and Apgar score of neonate 1,5 minutes after Parturent and blood volume were assessed and analysed. Results The MAP ,HR and SpO2 in group Ⅰ were markedly decreased postanesthesia （P〈0.05）. Bleeding volume , decomprnsation and shiver incidences and in group Ⅰ were significantly bigher than that in group Ⅱ and Ⅲ （ P〈 0.05, P〈 0.01, respectively） . The incidences of nause and vomiting in group Ⅰ was much lower than thal in others （P〈 0.05）. The incidence of pulling-dragging reflex in group Ⅲ was remarkable higher than that in others （ P〈0.01 ）. Apgar score were similar among three groups. Conclusions The upper anesthesia levels that has been adjusted to T6-8 in Parturients under CSEA was rational or ideal .

关 键 词：剖宫产 椎管内麻醉 

分 类 号：R614[医药卫生—麻醉学] R719.8[医药卫生—外科学]