剖宫产手术不同麻醉方法的对比研究

摘要

Objective: To determine the safety of regular doses of general anesthesia and combined spi-nal-epidural anesthesia on neonates delivered by cesarean sections. Method: Singleton pregnant women for whom elective cesarean sections were planned after 37 gestational weeks were allocated to general anesthesia group(platelet count < 50xl09L-l) and combined spinal-epidural anesthesia group ( platelet count>50× 10 /L-1) . Arterial and venous sample were withdrawn from the doubly clamped umbilical cord segment at delivery for the pH. All delivery times, hemodynamics of puerpera, and Apgar scores at lmin, 5min were recorded. Result: The mean Apgar score at 1 min for the general anesthesia group was 8.92±1.48 and 8.96± 1.74 for the combined spinal-epidural anesthesia group, without significant difference ( P > 0. 05) . The Apgar scores at 5 min of all newborns were 10. The mean umbilical arterial and venous blood pH of two groups was contiguous,There's no significant difference between the two groups ( P> 0.05) . The MAP decreased significantly in group CSEA at T2 ,T3( P< 0.05). Conclusion: Our prospective study suggests that mode of anesthesia does not influence significantly the outcome of newborn infants delivered by elective cesarean section. It seems that both general and combined spinal-epidural anesthesia can be used in elective term cesarean sections safely.%目的:通过对剖宫产手术全身麻醉与腰硬联合阻滞的对比研究,探讨两种麻醉方法对胎儿的安全性.方法:足月单胎妊娠行择期剖宫产的产妇中,选择血小板计数＜50×109L-1的病例行全身麻醉(GA组),血小板≥50×109L-1者行腰硬联合阻滞(CSEA组),两组各20例.两组产妇均在胎儿娩出时抽取脐动、静脉血,进行血气分析,分别记录两组术中的产妇血流动力学和新生儿取出时的1 min和5min Apgar评分,并比较这些指标.结果:GA组和CSEA组新生儿1minApgar评分分别为(8.92±1.48)、(8.96±1.74)分,5minApgar评分均为10分,两组比较,差异均无统计学意义(P＞0.05).两组胎儿娩出时脐动、静脉血的pH值比较,差异无统计学意义(P＞0.05).CSEA组T2、T3时,血压低于T1,且低于GA组(P＜0.05).结论:全身麻醉和腰硬联合阻滞均可安全地用于剖宫产.