超声定位L_(2)~L_(3)和L_(3)~L_(4)间隙腰硬联合麻醉在剖宫产术中麻醉效果的比较  

Comparison of the anesthetic effect of combined spinal-epidural anesthesia at L_(2)~L_(3)and L_(3)~L_(4)intervertebral space with ultrasound-guided technique in cesarean section

作　　者：陈远标 王菁[1] 周敏[1] 张龙新[1] 魏颖[1] CHEN Yuanbiao;WANG Jing;ZHOU Min;ZHANG Longxin;WEI Ying(Department of Anesthesiology,Fujian Maternity and Child Health Hospital,College of Clinical Medicine for Obstetrics&Gynecology and Pediatrics,Fujian Medical University,Fujian Province,Fuzhou 350002,China)

机构地区：[1]福建省妇幼保健院麻醉科福建医科大学妇儿临床医学院,福建福州350002

出　　处：《中国当代医药》2023年第31期125-128,共4页China Modern Medicine

基　　金：福建省本科高校教育教学改革研究项目(FBJG 20210134)。

摘　　要：目的探讨超声定位下L_(2)~L_(3)和L_(3)~L_(4)间隙腰硬联合麻醉对剖宫产的麻醉效果及不良反应的影响。方法选取2023年1月至2月福建省妇幼保健院的80例择期行剖宫产术的产妇为研究对象,按照随机数字表法分为超声定位下L_(2)~L_(3)间隙腰硬联合麻醉(Ⅰ组)以及L_(3)~L_(4)间隙腰硬联合麻醉(Ⅱ组),每组各40例。记录麻醉效果,腰硬联合麻醉后5(T_(1))、10(T_(2))、15 min(T_(3))的麻醉平面,低血压、心动过缓的发生率,间羟胺总使用量,呼吸困难、胸闷以及恶心、呕吐等不良反应的发生率。结果Ⅰ组的麻醉效果优于Ⅱ组,差异有统计学意义(P<0.05)。T_(1)~T_(3)时间点,Ⅰ组的麻醉平面均高于Ⅱ组,差异有统计学意义(P<0.05)。Ⅰ组低血压、心动过缓、呼吸困难等不良反应发生率高于Ⅱ组,差异有统计学意义(P<0.05)。Ⅰ组间羟胺总使用量多于Ⅱ组,差异有统计学意义(P<0.05)。结论超声辅助定位L_(2)~L_(3)和L_(3)~L_(4)间隙腰硬联合麻醉均可有效应用于剖宫产手术,L_(2)~L_(3)间隙腰硬联合麻醉的麻醉平面更高,麻醉效果较优,L_(3)~L_(4)间隙腰硬联合麻醉不良反应的发生率更低。Objective To investigate the effect and the adverse reactions of combined spinal-epidural anesthesia(CSEA)at L_(2)-L_(3)and L_(3)-L_(4)intervertebral space under ultrasound-guided technique in cesarean section.Methods Eighty women who underwent elective cesarean section in Fujian Maternal and Child Health Hospital from January to February 2023 were selected as the study objects.According to random number table method,they were divided into L_(2)-L_(3)space combined lumbar and epidural anesthesia(groupⅠ)and L_(3)-L_(4)space combined lumbar and epidural anesthesia(groupⅡ)under ultrasonic positioning,with 40 cases in each group.Anesthesia effect,anesthesia level 5(T_(1)),10(T_(2)),15 min(T_(3))after combined epidural anesthesia,incidence of hypotension,bradycardia,total usage of methanolamine,dyspnea,chest tightness,nausea,vomiting and other adverse reactions were recorded.Results The anesthetic effect of groupⅠwas better than that of groupⅡ,and the difference was statistically significant(P<0.05).From T_(1) to T_(3),the anesthesia plane of groupⅠwas higher than that of groupⅡ,and the difference was statistically significant(P<0.05).The incidence of hypotension,bradycardia and dyspnea in groupⅠwere higher than those in groupⅡ,and the differences were statistically significant(P<0.05).The total consumption of hydroxylamine in groupⅠwas higher than that in groupⅡ,and the difference was statistically significant(P<0.05).Conclusion Ultrasound-guided CSEA at L_(2)-L_(3)and L_(3)-L_(4)can be effectively applied to cesarean section.The anesthesia plane of CSEA at L_(2)-L_(3)gap is higher and the anesthesia effect is better,but the incidence of adverse reactions of combined spinal-epidural anesthesia at L_(3)-L_(4)is lower.

关 键 词：超声 腰硬联合麻醉 穿刺间隙 剖宫产 麻醉效果 不良反应 

分 类 号：R614[医药卫生—麻醉学]