小剂量腰麻-硬膜外联合阻滞麻醉用于妊娠期高血压剖宫产手术对产妇应激激素、免疫应答及新生儿的影响  

Effects of Low-dose Combined Spinal-Epidural Anesthesia on Maternal Stress Hormones,Immune Response and Neonates in Application of Cesarean Section for Women with Gestational Hypertension

作　　者：夏鹏志 周丹 任青竹 陈诚 XIA Peng-zhi;ZHOU Dan;REN Qing-zhu;CHEN Cheng(Department of Anesthesiology,Dazu People's Hospital,Chongqing 402360,China)

机构地区：[1]重庆市大足区人民医院麻醉科,重庆402360

出　　处：《解放军医药杂志》2022年第7期103-106,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：重庆市卫生计生委医学科研项目(2018MSXM104)。

摘　　要：目的探究小剂量腰麻-硬膜外联合阻滞麻醉用于妊娠期高血压剖宫产手术对产妇应激激素、免疫应答及新生儿的影响。方法回顾性分析2017年6月—2020年6月诊治的妊娠期高血压、择期行剖宫产手术98例的临床资料。根据麻醉方式分为对照组和联合组各49例。对照组给予硬膜外阻滞麻醉,联合组给予小剂量腰麻-硬膜外联合阻滞麻醉。观察2组麻醉效果、应激激素及免疫应答指标水平和新生儿情况。结果联合组麻醉优良率高于对照组(P<0.05)。2组术后12 h皮质醇、C-肽、晚期氧化蛋白产物高于麻醉前,但联合组低于对照组(P<0.05,P<0.01)。2组术后12 h免疫球蛋白M、免疫球蛋白G、免疫球蛋白A低于麻醉前,但联合组高于对照组(P<0.05,P<0.01)。2组新生儿1、5 min Apgar评分比较差异无统计学意义(P>0.05)。结论小剂量腰麻-硬膜外联合阻滞麻醉用于妊娠期高血压剖宫产手术中的麻醉效果较好,对产妇应激激素、免疫应答的影响小,对新生儿无严重影响。Objective To explore effects of low-dose combined spinal-epidural anesthesia on maternal stress hormones,immune response and neonates in application of cesarean section(C-section)for women with gestational hypertension.Methods Clinical data of 98 patients with gestational hypertension undergoing elective C-section who had been diagnosed and treated between June 2017 and June 2020 was retrospectively analyzed,and they were divided into control group and combination group(n=49 in each group)according to anesthesia methods.Control group was given epidural anesthesia,while combined group was given low-dose combined spinal-epidural anesthesia.Anesthesia effects,stress hormones,levels of immune response index and neonatal conditions were observed in two groups.Results The excellent and good rate of anesthesia in combination group was higher than that in control group(P<0.05).After operation for 12 h,levels of cortisol,C-peptide and advanced oxidized protein products were higher than those before anesthesia in two groups,but the levels in combination group were lower than those in control group(P<0.05,P<0.01);levels of immunoglobulin(Ig)-M,IgG and IgA were lower than those before anesthesia in two groups,and the levels in combination group were higher than those in control group(P<0.05,P<0.01).There were no significant differences in 1-min and 5-min Apgar scores of newborns between two groups(P>0.05).Conclusion Low-dose combined spinal-epidural anesthesia may achieve good anesthetic efficacy in application of C-section for women with gestational hypertension,which has little effects on maternal stress hormones and immune response,and has no serious effect on neonates.

关 键 词：高血压 妊娠性 剖宫产术 腰麻 麻醉 硬膜外 晚期氧化蛋白产物 免疫球蛋白M APGAR评分 

分 类 号：R714.246[医药卫生—妇产科学]