全麻和硬膜外麻对剖宫产术后母婴恢复的影响  

Effects of general anesthesia and epidural anesthesia on maternal and neonatal recover after cesarean section

作　　者：孙凯[1] 邵艳霞[1] 朱彤宇[1] 王玉洁 边洪春 王霄 SUN Kai;SHAO Yan-xia;ZHU Tong-yu;WANG Yu-jie;BIAN Hong-chun;WANG Xiao(General Hospital of Jinan Military Region,Shandong Jinan 250031,China)

机构地区：[1]济南军区总医院,山东济南250031

出　　处：《中国妇幼健康研究》2018年第7期890-893,共4页Chinese Journal of Woman and Child Health Research

摘　　要：目的评价全身麻醉和硬膜外麻醉对剖宫产术后母体和新生儿的影响。方法选择2014年1月—2016年6月在济南军区总医院择期剖宫产的产妇98例,随机分为全麻组50例和硬膜外麻醉组48例,分别在全身麻醉和硬膜外麻醉下接受剖宫产术,评价术中术后母婴情况。结果两组分别有50例和47例产妇完成研究,两组手术时间、1min Apgar评分、5min Apgar评分、新生儿重症监护病房(NICU)入住比例、术后疼痛VAS评分、红细胞压积下降值、术后血氧饱和度(SpO2)、术后止痛药物需求比例组间比较差异均无统计学意义(t/χ~2值分别为1.571、3.364、0.637、0.319、3.167、1.067、2.584、1.834,均P>0.05),硬膜外麻醉组术后血红蛋白、红细胞压积、止痛药物需求时间均高于全麻组(t值分别为3.978、5.674、5.559,均P<0.05);硬膜外麻醉组1min Apgar评分<7分比例、血红蛋白下降值、肠鸣音出现时间和排气时间均低于全麻组(χ~2/t值分别为4.513、6.008、4.669、6.013,均P<0.05);硬膜外麻醉组术中低血压发生率高于全麻组(χ~2=7.617,P=0.005),两组不良事件发生率分别为16.00%和41.67%,组间比较差异有统计学意义(χ~2=7.905,P=0.005)。结论剖宫产术中硬膜外麻醉的止痛效果与全身麻醉相似,而对母婴影响小、止痛药需求量少和胃肠道功能恢复快。Objective To evaluate the effects of general anesthesia and epidural anesthesia on mother and neonates after cesarean section.Methods Ninety-eight pregnant women undergoing selective cesarean section in General Hospital of Jinan Military Region from January 2014 to June 2016 were selected and randomly divided into general anesthesia group（n=50）and epidural anesthesia group（n=48）.Cesarean section was performed under general anesthesia and epidural anesthesia accordingly.Intraoperative and postoperative maternal and fetal situations were evaluated.Results There were 50 cases and 47 cases in two groups completing the study,respectively.There were no significant differences between two groups in operation time,1 min Apgar score,5 min Apgar score,neonatal intensive care unit（NICU）occupancy ratio,postoperative pain VAS score,hematocrit decreasing value,postoperative blood oxygen saturation（SpO2）and postoperative analgesic demand ratio（t/χ^2 value was 1.571,3.364,0.637,0.319,3.167,1.067,2.584 and 1.834,respectively,all P〉0.05）.Postoperative hemoglobin,postoperative hematocrit and postoperative analgesic demand time in epidural anesthesia group were higher than those in general anesthesia group（t value was3.978,5.674 and 5.559,respectively,all P〈0.05）.Ratio of 1 min Apgar score 〈7,hemoglobin decreasing value,time of occurrence of bowel sounds and exhaust time in epidural anesthesia group were lower than those in general anesthesia group（χ^2/t value was 4.513,6.008,4.669 and 6.013,respectively,all P〈0.05）.Incidence of hypotension in epidural anesthesia group was higher than that in general anesthesia group（χ^2= 7.617,P=0.005）.The incidence of adverse events in two groups was 16.00%and 41.67%,respectively,and the difference between two groups had significance（χ^2=7.905,P=0.005）.Conclusion Epidural anesthesia obtains similar analgesic effect in cesarean section to general anesthesia,and it has advantages of low effect on mothers and neonates,less demand of analgesic and fast r

关 键 词：全身麻醉 硬膜外麻醉 剖宫产 母婴安全 

分 类 号：R614[医药卫生—麻醉学]