超声辅助椎管内麻醉在肥胖合并妊娠期高血压疾病产妇剖宫产中的效果观察  

Effect of Ultrasound-assisted Intraspinal Anesthesia in Caesarean Section of Obese Women with Hypertensive Disorder Complicating Pregnancy

作　　者：王亚娟[1] 黄珊 宫伟 宋唯唯 吕林 WANG Yajuan;HUANG Shan;GONG Wei;SONG Weiwei;LYU Lin(Department of Anesthesiology,Baoding Maternal and Child Health Hospital,Baoding,Hebei 071000,China)

机构地区：[1]保定市妇幼保健院麻醉科,河北保定071000

出　　处：《临床误诊误治》2023年第7期115-119,共5页Clinical Misdiagnosis & Mistherapy

基　　金：河北省卫生健康委员会科研基金项目(20191233);保定市科学技术局项目(2241ZF086)。

摘　　要：目的 研究超声辅助椎管内麻醉在肥胖合并妊娠期高血压疾病(HDCP)产妇剖宫产术中的应用效果。方法 选取2020年1月—2022年7月62例肥胖合并HDCP剖宫产术患者,根据是否采用超声辅助定位分为超声组和对照组各31例。超声组采用超声引导定位下常规腰硬联合麻醉(CSEA),对照组采用常规CSEA。比较2组穿刺情况、麻醉效果、围麻醉期生命体征、脐动脉血气分析指标及麻醉相关并发症发生情况。结果 超声组1次穿刺成功率为100.00%(31/31)高于对照组的80.65%(25/31)(P<0.01)。超声组穿刺前定位、硬膜外腔穿刺、蛛网膜下腔穿刺、硬膜外导管置入及麻醉起效时间均短于对照组(P<0.01)。超声组麻醉效果评级优于对照组(P<0.01)。2组切皮时心率、舒张压、收缩压均高于麻醉前,胎儿取出时舒张压、收缩压均低于切皮时(P<0.05);且超声组切皮时心率及切皮时、胎儿取出时舒张压、收缩压变化幅度均优于对照组(P<0.05,P<0.01)。2组脐动脉血二氧化碳分压、血氧分压、乳酸值比较差异无统计学意义(P>0.05)。超声组穿刺点及周围疼痛发生率低于对照组(P<0.01)。结论 超声辅助椎管内麻醉用于肥胖合并HDCP剖宫产产妇效果较好,超声引导定位可促使麻醉药物到达指定椎间隙,缩短穿刺时间,提高1次穿刺成功率,且可稳定产妇术中生命体征,使得麻醉相关并发症发生率降低,手术安全性好。Objective To study the application effect of ultrasound-assisted intraspinal anesthesia in caesarean section of obese women with hypertensive disorder complicating pregnancy(HDCP).Methods From January 2020 to July 2022,62 obese patients with HDCP undergoing cesarean section were selected and divided into ultrasound group(n=31) and control group(n=31) according to application of ultrasound-assisted localization.The ultrasound group was treated with conventional combined spinal-epidural anesthesia(CSEA) under ultrasound guidance,and the control group was treated with conventional CSEA.The puncture condition,anesthetic effect,perianesthetic vital signs,umbilical arterial blood gas analysis index and anesthesia-related complications were compared between the two groups.Results The success rate of one puncture in ultrasound group was 100.00%(31/31),which was higher than that in control group [80.65%(25/31)](P<0.01).The pre-puncture location,epidural puncture,subarachnoid puncture,epidural catheter placement and the effective time of anesthesia in ultrasound group were shorter than those in control group(P<0.01).The anesthesia effect rating of ultrasound group was better than that of control group(P<0.01).The heart rate(HR),diastolic blood pressure(DBP) and systolic blood pressure(SBP) during skin incision in the two groups were higher than those before anesthesia,and DBP and SBP at the time of extraction were lower than those during skin incision(P<0.05).The changes of HR during skin incision,DBP and SBP at the time of extraction in ultrasound group were better than those in control group(P<0.05,P<0.01).There was no significant difference in the blood partial pressure of carbon dioxide,blood partial pressure of oxygen and lactic acid between the two groups(P>0.05).The incidence of puncture point and peripheral pain in ultrasound group was lower than that in control group(P<0.01).Conclusion Ultrasound-assisted intravertebral anesthesia has a good effect on obese women with HDCP undergoing cesarean section.Ultrasound-gu

关 键 词：高血压 妊娠性 肥胖症 剖宫产术 椎管内麻醉 超声检查 穿刺术 血压 血气分析 

分 类 号：R714.246[医药卫生—妇产科学]