妊娠期高血压孕妇剖宫产术硬膜外麻醉辅助七氟醚吸入麻醉效果及对血流动力学影响  

Effect of epidural anesthesia assisted by sevoflurane inhalation during cesarean section in women with gestational hypertension and its influence on the maternal hemodynamics

作　　者：纪筠 刘珺 徐余海 陶天柱 陈延英 杨晓明 JI Jun;LIU Jun;XU Yuhai;TAO Tianzhu;CHEN Yanying;YANG Xiaoming(Air Force Medical Center, Beijing, 100142)

机构地区：[1]空军特色医学中心,北京100142

出　　处：《中国计划生育学杂志》2021年第12期2570-2574,共5页Chinese Journal of Family Planning

摘　　要：目的:分析硬膜外麻醉辅助七氟醚吸入对妊娠期高血压孕妇剖宫产的麻醉效果及对血流动力学的影响。方法:选取2018年3月-2021年3月在本院行剖宫产手术的90例妊娠期高血压孕妇,随机数字表法分为观察组和对照组各45例。对照组采用硬膜外神经阻滞麻醉,观察组采用硬膜外神经阻滞辅助七氟醚吸入麻醉。分析比较两组麻醉效果和麻醉前(T1)、麻醉10min(T2)、胎儿娩出(T3)、手术结束(T4)血流动力学指标变化。结果:两组术中出血量、胎儿分娩时间、胎儿1min Apgar分、5min Apgar分及脐带血pH值等围术期指标均无差异(P>0.05)。观察组麻醉Ⅲ级占比44.4%、Ⅱ级占比35.6%、Ⅰ级占比20.0%,对照组麻醉Ⅲ级占比20.0%,Ⅱ级占比40.0%,Ⅰ级占比40.0%,观察组麻醉效果优于对照组(χ^(2)=7.290,P<0.05)。两组T1时血流动力学指标均无差异(P>0.05)。观察组T2、T3、T4时血流动力学水平均高于对照组,麻醉期间及术后不良反应发生率(11.1%)低于对照组(28.9%)(P<0.05)。结论:七氟醚辅助硬膜外麻醉用于妊娠期高血压孕妇剖宫产术麻醉起效快、不良反应少,且可有效稳定术中血流动力学水平。Objective: To analyze the anesthesia effect of epidural anesthesia assisted by sevoflurane inhalation of pregnant women with gestational hypertension during cesarean section, and to study its influence on the maternal hemodynamics. Methods: A total of 90 pregnant women with gestational hypertension who underwent cesarean section were selected and randomly divided into two groups(45 cases in each group) by random number table from March 2018 to March 2021. The women in the control group were anesthetized with epidural nerve block, while the women in the experimental group were anesthetized with epidural nerve block assisted by sevoflurane inhalation. The anesthesia effect and maternal hemodynamic change of the women before anesthesia(T1), 10 min after anesthesia(T2), fetal delivery(T3), and at the end of surgery(T4) were analyzed and compared between the two groups. Results: There were no significant differences in the intraoperative blood loss, the duration of fetal delivery, the fetal Apgar score at 1 min and 5 min after born, and the umbilical cord blood pH value of the women between the two groups(P>0.05). The proportion of class Ⅲ, Ⅱ, and Ⅰ of anesthesia of the women in the experimental group were 44.4%, 35.6%, and 20.0%, respectively. The proportion of class Ⅲ,Ⅱ, and Ⅰ of anesthesia of the women in the control group were 20.0%, 40.0%, and 40.0%, respectively. The anesthesia effect of the women in the experimental group was significantly better than that of the women in the control group(χ^(2)=7.290, P<0.05). There were no significant differences in the values of MAP, HR, CO, CI, and other hemodynamic indexes of the women at T1 between the two groups(P>0.05). The values of MAP, HR, CO, and CI of the women in the experimental group at T2, T3 and T4 were significantly higher than those of the women in the control group,and the incidence of adverse reactions during and after anesthesia(11.1%)of the women in the experimental group was significantly lower than that(28.9%)of the women in the control gr

关 键 词：妊娠期高血压 剖宫产 硬膜外麻醉 七氟醚 麻醉效果 血流动力学 

分 类 号：R61[医药卫生—外科学]