腰硬联合麻醉与硬膜外麻醉对重度子痫前期剖宫产产妇血流动力学和新生儿apgar评分的影响

摘要

Objective To compare the hemodynamics and apgar score in severely preeclampsia patients treated by epidural anesthesia or combined spinal-epidural anesthesia during cesarean section.Methods 77 patients with pre-eclampsia were selected and randomly divided into 2 groups.40 cases received epidural analgesia (EA),while 37 pa-tients received combined spinal-epidural analgesia (CSEA).All patients were used cesarean section for the termination of pregnancy.The mean arterial pressure (MAP),heart rate (HR),pulse oxygen saturation (SpO2 )were detected and compared before,during and after anesthesia.The apgar score was compared 1 min and 5 min after delivery.Results There were no differences in hemodynamics before anesthesia (P >0.05),and they remained steady during and after anesthesia in both groups (P >0.05).The time of block onset and reaching to the highest block plane in CSEA group were significantly less than those in EA group (P <0.05),while the dosage of ephedrine was significantly higher in CSEA group (P <0.05).There was no difference in apgar score 1 min or 5 min after delivery (P >0.05).The pull dis-comfort in CSEA group was less common than that in EA group (P <0.05).Conclusion In the treatment of cesarean section with preeclampsia,spinal-epidural anesthesia has no effect on hemodynamics and apgar score compared with epi-dural anesthesia,but it contributes to less anesthesia induction time and pull discomfort.%目的：对比研究腰硬联合麻醉与硬膜外麻醉应用于重度子痫前期剖宫产患者，对产妇血流动力学和新生儿 apgar 评分的影响。方法选取2013年1月至2015年6月在我院治疗的重症子痫前期患者，将其随机分为2组，两组患者均采用剖宫产术结束妊娠。硬膜外麻醉组（EA 组）40例患者纳入研究，腰硬联合麻醉组（CSEA 组）37例患者纳入研究。比较两组患者在麻醉前（T0）、麻醉平稳后（T1）、开始手术时（T2）、胎儿娩出后（T3）、手术结束时（T4）的平均动脉压（MAP）、心率（HR）及指脉氧（SpO2）各指标的差异；并比较两组患者的麻醉效果及胎儿娩出后1 min 和5 min 时的 apgar 评分。结果麻醉前（T0），两组患者的 MAP、HR 及 SpO2的差异无统计学意义（P ＞0．05）；麻醉过程中，两组患者仅在胎儿娩出后（T3）的 HR 有统计学差异（P ＜0．05），其余各时间点的各指标差异无统计学意义（P ＞0．05）。CSEA 组患者麻醉起效时间及达到最高阻滞平面时间均明显短于 EA 组（P ＜0．05），但麻黄碱用量明显多于EA 组（P ＜0．05）。两组胎儿在娩出后1 min 及5 min 时的 apgar 评分差异均无统计学意义（P ＞0．05）。CSEA 组的牵拉不适感发生率低于 EA 组（P ＜0．05），其余不良反应未见明显差别（P ＞0．05）。结论与硬膜外麻醉相比，腰硬联合麻醉应用于重度子痫前期剖宫产患者，对产妇血流动力学和新生儿 apgar 评分无明显影响，但有助于缩短麻醉诱导时间，缓解牵拉不适感。