前置胎盘并发脐带脱垂行剖宫产术中不同麻醉药物及穿刺间隙联合适合目标导向式控制腰麻平面效果  

Effect comparison of different anaesthetic drugs and puncture interspace combined with target-oriented control of spinal anesthesia level during cesarean section of women with placenta previa complicating umbilical cord prolapse

作　　者：未国徽 孙颜 刘志杰 吕航宇[1] 陈永学[1] 王新波[1] WEI Guohui;SUN Yan;LIU Zhijie;LV Hangyu;CHEN Yongxue;WANG Xinbo(Handan Central Hospital,Hebei Province,056001)

机构地区：[1]河北省邯郸市中心医院,056001

出　　处：《中国计划生育学杂志》2022年第2期339-343,共5页Chinese Journal of Family Planning

摘　　要：目的:分析不同麻醉药物及穿刺间隙联合适合目标导向式控制腰麻平面在前置胎盘并发脐带脱垂患者剖宫产术中应用效果。方法:本院2017年1月-2021年1月收治的行剖宫产终止妊娠的前置胎盘合并脐带脱垂患者80例纳为研究对象,电脑随机软件分两组各40例,术中均行腰麻-硬膜外联合阻滞,分别采用0.67%罗哌卡因(罗哌卡因组),穿刺间隙为L3~4或0.5%布比卡因(布比卡因组),穿刺间隙为L2~3,两组均通过体位调节控制麻醉阻滞平面至目标,统计两组切皮时刻及胎儿娩出时刻阻滞平面,术中牵拉情况以及术中低血压发生率。结果:两组切皮时刻及胎盘娩出时刻阻滞平面均存在差异(P<0.05),硬膜外麻醉药物追加情况两组切皮时刻无差异(P>0.05),胎盘娩出时刻布比卡因组(25.0%)多于罗哌卡因组(5.0%)(P<0.05),胎盘娩出时刻出现牵拉反应布比卡因组(32.5%)多于罗哌卡因组(12.5%)(P<0.05)。术中体位改变的两个时刻低血压发生率均罗哌卡因组低于布比卡因组(10.0%比30.0%,27.5%比50.0%)(P<0.05)。结论采用0.67%罗哌卡因联合体位调节的目标导向平面阻滞,能有效控制剖宫产阻滞平面,降低术中低血压发生,在保障前置胎盘并发脐带脱垂患者剖宫产安全性中效果更佳。Objective:To analyze the application effect of different anaesthetic drugs and puncture interspace combined with target-oriented control of spinal anesthesia level during cesarean section of women with placenta previa complicating umbilical cord prolapse.Methods:80 women with placenta previa complicating umbilical cord prolapse who wanted cesarean section were enrolled in this study from January 2017 to January 2021.These women were divided into two groups(40 cases in each group)by computer.All women received combined spinal epidural anesthesia(CSEA)during cesarean section.Anesthesia of the women in group A was induced at the L3-4 interspaces with 0.67%ropivacaine,and which of the women in group B was induced at L2-3 interspaces with 0.5%bupivacaine.The postural adjustments of the women in the two groups were designed to control the spinal anesthesia level.The anesthesia levels at the time of skin incision and the time of the fetal delivery of the women in the two groups were recorded.The intraoperative tractive situation and the rate of intraoperative hypotension of the women in the two groups were observed.Results:There were significant differences in anesthesia block level at the time of skin incision and the placenta delivery of the women between the two groups(P<0.05),but there was no significant difference in the epidural anesthesia dosage addition at the time of skin incision of the women between the two groups with anesthesia(P>0.05).The rate of the epidural anesthesia dosage addition(25.0%)of the women in group B at the time of placenta delivery was significantly higher than that(5.0%)of the women in group A(P<0.05).The incidence of tractive reaction(32.5%)of the women in group B at the time of placenta delivery was significantly higher than that(12.5%)of the women in group A(P<0.05).The incidences of hypotension(30.0%and 50.0%)of the women in group B at the time of skin incision and the time of placenta delivery were significantly higher than those(10.0%and 27.5%)of the women in group A(P<0.05).Conclusi

关 键 词：胎盘前置并发脐带脱垂 剖宫产术 麻醉 适合目标导向式平面控制 罗哌卡因 布比卡因 效果比较 

分 类 号：R614[医药卫生—麻醉学]