头高位10°下行腰麻硬膜外联合麻醉对剖宫产产妇血流动力学的影响  

Influence of combined spinal epidural anesthesia with head -up of 10°on maternal hemodynamics during ;cesarean section

作　　者：沈虹春[1] 高丽君[1] 蔡利[1] 

机构地区：[1]慈溪市妇幼保健院麻醉科,浙江省慈溪315300

出　　处：《中国基层医药》2016年第19期2988-2992,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：探讨头高位10°下行腰麻硬膜外联合麻醉（CSEA）剖宫产的阻滞效果及其对产妇血流动力学的影响。方法选取拟行剖宫产的孕妇120例，以随机数字表法分为 A、B、C 组，每组各40例。A 组取平卧位，B 组取头高位10°C 组取头高位20°，均行 CSEA。比较各组麻醉前（T0）、麻醉后5 min（T1）、切皮时（T2）、胎儿娩出即刻（T3）、手术结束时（T4）各时点的血流动力学参数，进行麻醉阻滞效果评分，记录麻黄碱、局麻药使用情况及不良反应等。结果与 T0时点比较，T1时 A 组收缩压（SBP）、舒张压（DBP）等血流动力学指标降低，T2、T3时升高（t ＝3．63-7．25，P ＜0．05或 P ＜0．01），T4时三组血流动力学各指标变化差异均无统计学意义（t ＝0．00-0．80，均 P ＞0．05）。与 B、C 组比较，A 组 T1、T2、T3时点 SBP、DBP 等血流动力学指标差异有统计学意义（t ＝3．63-7．25，P ＜0．05或 P ＜0．01），而 B 组、C 组血流动力学指标比较，差异均无统计学意义（t ＝0．00-0．93，P ＞0．05）。A、B、C 组麻醉阻滞效果评分分别为（2．0±0．3）分、（2．5±0．2）分、（2．6±0.2）分，B、C 组评分均高于 A 组（t ＝3．92、4．01，P ＜0．05）。A 组使用麻黄碱的例数和总量均高于 B、C 组（χ2＝31.43、50．61，t ＝16．27、20．17，P ＜0．01），C 组调整手术体位例数、追加局麻药例数均显著高于 B 组（χ2＝23.85、28．47，P ＜0.01）。结论头高位10°下行 CSEA 具有较为完善的麻醉效果，且产妇血流动力学比较稳定，较好满足手术要求，而且方便手术操作，优于平卧位和头高位20°的麻醉阻滞效果。Objective To explore the anesthesia effect and influence of combined spinal epidural anesthesia （CSEA）with head -up of 10°on maternal hemodynamics during cesarean section.Methods 120 pregnant women undergoing cesarean section were selected,and were randomly divided into group A,B and C,40 cases in each group. Three groups were all given CSEA,yet pregnant women in group A were taken supine position,group B was taken head-up of 10°,and group C was taken head -up of 20°.Hemodynamic parameters of three groups of the following time points were compared,including before anesthesia（T0 ）,5min after anesthesia（T1 ）,skin incision（T2 ）,fetal disen-gagement immediately（T3 ）,and operation at the end（T4 ）,also anesthesia effect was recorded,and usage of ephedrine and local anesthetic was noted,and adverse reactions were compared.Results Compared with T0 ,group A＇s hemody-namics in T1 decreased,including systolic blood pressure （SBP）,diastolic blood pressure （DBP）,and increased in T2 and T3 ,yet there were no statistical differences on hemodynamics in three groups in T4 .Compared with group B and C,there were statistical differences on hemodynamics in T1 ,T2 and T3 in group A（t =3.63 -7.25,P 〈0.05 or P 〈0.01）,yet there were no statistical differences on hemodynamics in group B and C（t =0.00 -0.93,all P 〉0.05）. Anesthesia block scores in group A,B and C were （2.0 ±0.3）points,（2.5 ±0.2）points,（2.6 ±0.2）points,and scores of B and C were higher than that in group A（t =3.92,4.01,all P 〈0.05）.Cases and total usage of ephedrine in group A were higher than those of group B and C（χ2 =31.43,50.61,t =16.27,20.17,all P 〈0.01）.Cases of adjusting surgical position,and addition of local anesthetic in group C were significantly higher than those of group B （χ2 =23.85,28.47,all P 〈0.01）.Conclusion It has better anesthetic effect of taking CSEA by head -up of 10° and maternal hemodynamics are more stable,can better meet operation＇s requirements,also with eas

关 键 词：剖宫产 血流动力学 腰麻硬膜外联合麻醉 体位 

分 类 号：R614[医药卫生—麻醉学]