腰硬联合麻醉时腰麻针侧孔方向对剖宫产术PIH产妇应激、认知功能影响  

Effects of the lateral puncture direction of lumbar anesthesia combined spinal epidural anesthesia during cesarean section of pregnant women with pregnancy-induced hypertension on their stress and cognitive function

作　　者：张子栋 张延红 齐佳奇 王晋平 ZHANG Zidong;ZHANG Yanhong;QI Jiaqi;WANG Jinping(Jinahou Medical University Graduate Training Base(Jincheng People's Hospital,Shansi Province),048000;The Eighth People's Hospital of Hengshui,Hebei Province)

机构地区：[1]锦州医科大学研究生培养基地,山西省晋城市人民医院,048000 [2]河北省衡水市第八人民医院

出　　处：《中国计划生育学杂志》2024年第1期62-67,共6页Chinese Journal of Family Planning

摘　　要：目的:探究腰硬联合麻醉(CSEA)时腰麻针侧孔方向对妊娠期高血压(PIH)剖宫产产妇应激激素、认知功能的影响.方法:随机数表法将本院2021年1月-2022年6月行剖宫产手术的102例PIH患者分为3组各34例,各组均行CSEA,卧位、穿刺间隙相同,Ⅰ组腰麻针侧孔方向朝头、Ⅱ组侧孔方向朝尾、Ⅲ组侧孔方向先朝头后朝尾.对比各组血流动力学、应激激素指标变化,评价麻醉效果及安全性,简易智力量表(MMSE)评估各组认知功能,统计术后72h内认知障碍发生率.结果:3组运动/感觉阻滞起效时间、镇痛效果、不同时间点心率(HR)及MMSE评分均无差异(P>0.05),Ⅰ组最高阻滞平面均广于Ⅱ组和Ⅲ组,腰麻后5min时舒张压、收缩压水平均低于Ⅱ组和Ⅲ组(均P<0.05),而Ⅱ组与Ⅲ组无差异(P>0.05).术后24h血清C-肽、皮质醇、晚期氧化蛋白产物水平3组均上升且I组、Ⅲ组低于Ⅱ组(P<0.05),Ⅰ组与Ⅲ组无差异(P>0.05);3组术后24hMMSE评分均下降(P<0.05)但组间无差异.3组术后72h内认知障碍发生率无差异(P>0.05);3组中Ⅰ组恶心呕吐(20.6%)、低血压(32.4%)发生率最高,Ⅱ组内脏牵拉反应发生率(17.7%)最高(P<0.05).结论:腰麻针侧孔先朝头后朝尾方向给药相对麻醉镇痛效果较好,不良反应少,对妊娠期高血压患者的应激激素指标、认知功能影响较小.Objective:To explore the efeetse of the lateral puncture dretion of lumbar anesthesia combined spinal epi-dural anesthesia(CSEA)during cesarean section of pregnant women with pregnancy-induced bhypertension(PIH)on their stress hormone and cognitive funetion.Methods:A total of 102 pregnant women with PIH who wanted cesarean section were divided into three groups(34 cases in each group)by the random number table method from January 2021 to June 2022.CSEA was performed in the women with the same elinostatism and puneture gap in the three groups.The lateral hole of lumbar anesthesia needles in groupⅠwas facing head,which in group Ⅱ were facing tail,and which in groupⅢwere facing head and then tail.The hemodynamics and stress hormone indexes changes of the women were compared among the three groups.The anesthetic effect and safety of the women in the three groups were evaluated.The cognitive function of the women in the three groups was evaluated by the Mini Mental State Examination(MMSE),and the incidence of cognitive impairment of the women within 72h after cesarean section was calculated.Results:There were no significant differences in the onset time of motor/sensory block,the analgesic effect,the heart rate(HR)and MMSE score at different time points of the women among the three groups(P>-0.05).The area of the highest block level of the women in group Ⅰ was significantly wider than that of the women in groupⅡand that of the women in groupⅢ.The values of diastolic blood pressure and systolic blood pressure of the women in groupⅠat 5min after spinal anesthesia were significantly lower than those of the women in groupⅡand those of the women in groupⅢ(all P<0.05).There were no significant differences in area of the highest block level and the values of diastolie blood pressure and systolic blood pressure of the women between groupⅡand groupⅡ(P>0.05).The levels of serum C-peptide,cortisol and advanced oxidation protein products of the women in the three groups at 24 hours after cesarean section had

关 键 词：妊娠期高血压 剖宫产 腰硬联合麻醉 针侧孔方向 应激激素 认知功能 

分 类 号：R614[医药卫生—麻醉学]