腰麻-硬膜外联合麻醉在剖宫产手术中的应用  

Application of combined spinal epidural anesthesia during the operations of cesarean section

作　　者：陆伟峰 陆宏 戴晓红 

机构地区：[1]无锡市滨湖区中医院麻醉科,江苏无锡214121

出　　处：《西部医学》2006年第5期550-551,共2页Medical Journal of West China

摘　　要：目的腰麻-硬膜外联合麻醉在剖宫产手术中的可行性。方法100例有剖宫产指征患者随机分为两组:试验组用腰麻-硬膜外联合麻醉,对照组用单纯硬膜外麻醉,每组50例。观察指标:麻醉前、麻醉显效后、胎儿娩出后5分钟的血压,麻醉显效时间(麻醉注药至手术开始的时间),胎儿娩出后1、5分钟时Apgarl评分,术中辅助镇痛药情况,术后头痛情况并统计。结果A组麻醉显效后,血压下降较明显,与B组比较差异有统计学意义(P<0.05),但胎儿娩出后5分钟A、B两组血压变化无差异(P>0.05)。A组麻醉起效时间比B组明显缩短(P<0.05)。两组新生儿娩出后1分钟时Apsar评分无差异(P>0.05)。B组有26%由于镇痛不全辅助镇痛药,A、B两组均无麻醉头痛并发症。结论腰麻-硬膜外联合麻醉在剖宫产术的麻醉可行,比单纯硬膜外麻醉有更大优越性。Objective To observe the feasibility of combined spinal epidural anesthesia （CSEA） during the operation of cesarean section. Methods A hundred women undergoing cesarean section were randomly divided into 2 groups with 50 patients in each group. Group A （test group） was conducted CSEA and Group B, epidural anesthesia. The parameters measured included： BP at the 5 th minute before and after anesthesia, at the 5 th minute from anesthesia taking effect and after delivery as well as the time needed for effectual anesthesia （from anesthetic injection to the beginning of operation）, Apgar＇s score at the 1st and 5th minute after fetal expulsion, the dosage of auxiliary analgesic-using during operation, and the occurrence and degree of headache after operation. Results BP was lower in Group A than Group B after anesthetic taking effect （P〈0.05） ,but there was no significant difference at the 5th min after fetal expulsion between the two groups. （P〉0. 05）. The time for anesthesia taking effect was shorter in Group A than Group B（P〈0.05）. The 1st minute Apgar＇s score in the two groups after fetal expulsion was similar（P〉0.05）. 26% women of Group B needed auxiliary analgesic. There was no headache complained during or after operation in all the women. Conclusion CSEA is feasible to use during cesarean section, and it has been corroborated more favorable and effective than simple epidural anesthesia.

关 键 词：腰麻-硬膜外联合麻醉 血压改变 新生儿Apgar评分 

分 类 号：R614.41[医药卫生—麻醉学] R719.8[医药卫生—外科学]