腰麻-硬膜外联合麻醉和硬膜外麻醉在瘢痕子宫剖宫产术中的比较  

Efficacy uterus d comparison of combined spinal epidural anesthesia and epidural anesthesia in the scarred uring cesarean section

作　　者：裘剑波[1] 裘宁辉 刘超[1] 林家燕[1] 张毅[1] 

机构地区：[1]解放军113医院麻醉科,浙江宁波315040

出　　处：《中国实用医刊》2012年第18期36-38,共3页Chinese Journal of Practical Medicine

摘　　要：目的比较腰麻-硬膜外联合麻醉和硬膜外麻醉在瘢痕子宫剖宫产术中的麻醉效果和安全性。方法120例瘢痕子宫患者行剖宫产术，年龄23～42岁，平均（324-11）岁，按抽签法随机分为连续硬膜外麻醉（EA）组60例和腰麻-硬膜外联合麻醉（CSEA）组60例。监测心电图、血压、心率、呼吸频率和动脉血氧饱和度，用针刺法测定两组的痛觉消失平面（麻醉平面），记录感觉阻滞起效时间（指给药后感觉阻滞部位发热、麻木等的时间），用改良的Browage分级法评定下肢运动阻滞效果，评定麻醉效果，新生儿的Apgar评分，术后随访麻醉后头痛、呕吐等不良反应。结果EA组感觉阻滞起效时间明显慢于CSEA组，麻醉平面明显低于CSEA组，下肢运动阻滞效果小于CSEA组，差异有统计学意义（P〈0．01或〈0．05）。EA组中7例术中由于麻醉阻滞不全、有较强痛感而不能耐受者加局部麻醉浸润或辅助静脉镇痛药完成手术，2例术中由于无法耐受手术而改气管插管全身麻醉；CSEA组中无一例辅助静脉镇痛药和改全身麻醉，CSEA组麻醉效果明显优于EA组（P〈0．01）。CSEA组术后无一例腰麻后头痛和神经系统并发症发生。胎儿娩出时及出生后1minApgar评分CSEA组明显高于EA组（P〈0．05），出生后5、10minApgar评分两组比较差异无统计学意义（P〉0．05）。结论只要严格控制注药的速度和麻醉平面，采用小剂量麻醉药，CSEA应用于瘢痕子宫剖宫产术是安全的，麻醉效果是确切的，可缩短胎儿娩出时间，提高新生儿Apgar评分，与EA比较有很大的优越性，可作为瘢痕子宫剖宫产术的首选麻醉方法。Objective To compare the anesthetic effect and safety of combined spinal epidural anesthesia （CSEA） and epidural anesthesia （EA） in the scarred uterus during cesarean section. Meth- ods One hundred and twenty cases of the scar uterine pregnant woman aged 23 - 42, were randomly di- vided into two groups, EA group （60 cases）and CSEA group（60 cases）. In each group, patient were given EA or CSEA before cesarean section, and the ECG, BP, HR, RR and SpO2 were monitored. The pain disappear plane by acupuncture was determined, and sensory block onset time （when the senso- ry block parts have fever or numbness after the drug delivery time） was recorded. The lower limb motor block effects were indentified by the improved Browage grading, the Apgar scores of the newborns were recorded and the adverse reactions such as headache, vomiting after anesthesia were observed. Results The sensory block onset time of EA group was significantly slower than that of CSEA group （ P 〈 0.05） , the pain disappear plane of CSEA group was higher than that of EA group （ P 〈 0. 05）, the limb motor block effect of EA group was much lower than that of CSEA group （P 〈 0. 01 ）. Because of insufficient anesthesia, 7 cases in EA group could not tolerate the surgery, and had to add assisted local infiltration anesthesia or intravenous analgesics to complete the operation, 2 of them changed to general anesthesia. None of the patients in CSEA group had assisted intravenous analge- sics or changed to general anesthesia, the anesthetic effect was significantly better than EA group （P 〈 0. 01）. There were no cases of headache or neurological complications occurred in CSEA group after anesthesia. The Apgar scores of the newborns when the baby was delivered and 1 min after birth in CSEA group were significantly better than those in EA group （ P 〈 0.05 ） , and there was no significant difference in the Apgar scores 5 min or 10 min after birth between the two groups （ P 〉 0.05 ）. Con- clusions By small do

关 键 词：腰麻-硬膜外联合麻醉 硬膜外麻醉 瘢痕子宫 剖宫产术 

分 类 号：R614[医药卫生—麻醉学]