腰麻硬膜外联合麻醉与硬膜外麻醉对剖宫产患者血流动力学的影响

目的:探讨腰麻硬膜外联合麻醉与硬膜外麻醉对剖宫产患者血流动力学的影响。方法:选择我院2013年12月至2014年12月收治的80例行剖宫产手术产妇,按随机数字表法平均分为A组及B组各40例,A组产妇使用腰麻硬膜外联合麻醉(CSEA),B组产妇使用硬膜外麻醉(EA),比较两组产妇麻醉效果,血流动力学变化、新生儿Apgar评分及产妇不良反应发生情况。结果:A组产妇麻醉效果Ⅲ级比率85.0%,明显高于B组的22.5%(P0.05)。A组产妇心率(HR)在胎儿娩出10 min(T3)及手术结束(T4)时刻明显高于B组,收缩压(SBP)和舒张压(DBP)在胎儿娩出即刻(T2)明显高于B组,平均动脉压(MAP)在麻醉前(T1)和麻醉后(T4)明显高于B组,每博输出量(SV)在T2时刻明显低于B组,比较差异具有统计学意义(P0.05);两组产妇心输出量(CO)各时刻比较差异无统计学意义(P0.05)。A组新生儿在娩出1 min时Apgar评分明显高于B组(P0.05)。A组不良反应发生率为5.0%,B组产妇不良反应发生率为10.0%,两组比较差异无统计学意义(P0.05)。结论:对剖宫产手术患者使用CSEA麻醉效果明显优于EA,且患者血流动力学更为稳定,麻醉效果较完善,安全性高,可应作为剖宫产手术首选的麻醉方式。

Influence of Combined Spinal Epidural Anesthesia and Epidural Anesthesia on Hemodynamics of Cesarean Section Puerperas

Objective:To investigate the influence of combined spinal epidural anesthesia(CSEA) and epidural anesthesia(EA) on hemodynamics in patients with cesarean section.Methods:Selected 80 cases cesarean section puerperas who were underwent the operation in our hospital fromDecember 2013 to December 2014, they were averagely divided into group A and group B according to the randomnumber table method,group A was anaesthetized by CSEA,while group B was anaesthetized by EA, compared the anesthesia effect, hemodynamic difference,neonatal Apgar score and the incidence of adverse reactions in two groups.Results:The grade III rate of anesthesia effect in group A was 85.0%, which was significantly higher than 22.5% in group B, the difference was statistically significant (P<0.05). Heart rate (HR) of group A was higher than group B at 10 min after delivery(T3) and the end of operation(T4), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher than group B right at delivery(T2), mean arterial pressure (MAP) of group A was higher than group B before (T1) and after anesthesia (T4), but the stroke volume (SV) of group A was lower than group B at T2, above differencs were statistically significant (P<0.05), while the cardiac output (CO) in the two groups had no significant differences at each time point (P>0.05). Neonatal Apgar score in group A at 1min after delivery was significantly higher than group B, the difference was statistically significant (P<0.05). The incidence of adverse reactions in group A was 5.0%, and 10.0%in group B, the difference was no statistical significance(P>0.05).Conclusion:CSEA is obviously better than EA for the anesthesia of cesarean section, and the hemodynamics is more stable, the safety is higher, which can take as the first choice for the anesthesia of cesarean section.