剖宫产术不同体位穿刺腰麻-硬膜外联合麻醉效果及对新生儿影响  

Effect of combined spinal and epidural anesthesia in different positions during cesarean section of women and its impact on the newborns

作　　者：计成忠 舒波 王文霞 JI Chengzhong;SHU Bo;WANG Wenxia(The First Affiliated Hospital of Anhui Medical University(Feidong County People's Hospital),Hefei,Anhui Province,231600;Bengbu First People's Hospital of Anhui Province)

机构地区：[1]安徽医科大学第一附属医院东城院区(肥东县人民医院),合肥231600 [2]安徽省蚌埠市第一人民医院

出　　处：《中国计划生育学杂志》2023年第5期1082-1086,共5页Chinese Journal of Family Planning

摘　　要：目的:探讨剖宫产不同体位穿刺腰麻-硬膜外联合麻醉效果及对新生儿影响。方法:选取2020年7月-2022年7月本院择期剖宫产足月产妇90例,根据腰麻-硬膜外联合麻醉穿刺体位不同随机均分为坐位组(45例)和卧位组(45例),比较两组手术麻醉效果、血流动力学指标、不良反应以及新生儿结局。结果:坐位组术中麻黄碱总用量(8.5±1.5mg)低于卧位组(10.3±1.8mg),且到达T5时间(9.4±2.7min)以及达到最终阻滞平面时间(12.7±2.9min)均短于卧位组(13.8±2.7min、16.5±3.1min),镇痛效果优于卧位组,麻醉后血流动力学指标优于卧位组,术后恶心呕吐、头痛、低血压和产后出血等不良反应总发生率(15.6%)低于卧位组(35.6%)(P<0.05),两组新生儿出生1min 5minApgar评分及窒息情况无差异(P>0.05),但新生儿脐动脉血pH值坐位组(7.32±0.05)高于卧位组(7.27±0.09)(P<0.05)。结论:剖宫产腰麻-硬膜外联合麻醉穿刺体位采用坐位的麻醉效果和血流动力学指标优于卧位穿刺,术后不良反应减少,对新生儿无明显影响。Objective:To explore the effect of combined spinal and epidural anesthesia in different positions during ce-sarean section,and to study its impact on the newborns.Methods:90 full term pregnant women who wanted elective cesarean section from July 2020 to July 2022 were randomly divided into group A(45 cases with sitting position of lum-bar anesthesia epidural anesthesia puncture)and group B(45 cases with lying position of lumbar anesthesia epidural an-esthesia puncture).The anesthesia effect,the hemodynamic indicators values,the adverse reactions rate,and the neo-natal outcomes of the women were compared between the two groups.Results:The total amount of ephedrine(8.5±1.5mg)of the women in group A was significantly lower than that(10.3±1.8mg)of the women in group B,and the time of ephedrine reached to T5(9.4±2.7/min)and the time of ephedrine reached to the final block plane(12.7±2.9.min)of the women in group A were significantly shorter than those(13.8±2.7min and 16.5±3.1min)of the women in group B.The analgesic effect of the women in group A was significantly better than that of the women in group B,the hemodynamic indexes values after anesthesia of the women in group A were significantly better than those of the women in the group B.The overall incidence of postoperative nausea,vomiting,headache,hypotension and pos tpar-tum hemorrhage(15.6%)of the women in group A was significantly lower than that(35.6%)of the women in group B(P<0.05),and there were no significant differences in the neonatal asphyxia and the neonatal 5min Apgar score after birth between the two groups(P>0.05).The neonatal umbilical arterial blood pH value(7.32±0.05)of the women in group A was significantly higher than that(7.27±0.09)of the women in group B(P<0.05).Conclusion:The anesthesia effect and the hemodynamic indicators values of the sitting position for combined spinal and epidural anes-thesia puncture during cesarean section are better than those of the lying position puncture,with less postoperative ad-verse reactions of the wo

关 键 词：剖宫产 腰麻-硬膜外联合麻醉 穿刺体位 麻醉效果 不良反应 新生儿结局 

分 类 号：R614[医药卫生—麻醉学]