肥胖产妇剖宫产联合阻滞麻醉后感觉平面阻滞范围及血流动力学研究

摘要

Objective: To observe sensory block scope and hemodynamic change characteristics of normal parturients and obese parturients before the operation. Methods:60 ASA I or II parturients, who underwent caesarean section with combined spinal-epidural anesthesia at L2 ~L3, were divided into two groups:normal parturients group (group A, BMI<30kg/m2) and obese parturi﹣ents group (group B, BMI>30kg/m2), each group of 30 cases. The value of BMI, anesthetic sensory block scope and hemodynamic parameters [SBP (systolic blood pressure), DBP(diastolic blood pressure) and HR(heart rate)] at 5min before anesthesia (T0) and 5min after anesthesia (T1) were measured. Results:Under the same dose of anesthetic drugs, compared with group A, group B block range was higher (P<0. 05). Compared group A with group B, SBP, DBP and HR at T0 did not show significant differences (P>0. 05);however, they showed significant differences at T1(P<0. 05). There were significant differences in SBP and DBP in group A between at T0 and T1(P<0. 05), but there was no significant difference in HR (P>0. 05). There were significant differences in SBP, DBP and HR in group B between at T0 and T1(P<0. 01). Conclusions:Compared with normal weight parturients, obese parturients' cesarean operation with combined spinal epidural anesthesia should be more concerned about the block scope and hemodynamic chan﹣ges.%目的：：观察体重正常产妇与肥胖产妇剖宫产手术开始前麻醉感觉平面阻滞范围及血流动力学变化的特点。方法：ASA I或Ⅱ级择期剖宫产手术的产妇60例,均在L2~L3腰硬联合麻醉下行剖宫产手术,根据体重指数将产妇分为正常组(A组, BMI<30kg/m2)和肥胖组(B组, BMI>30kg/m2),每组30例。测量产妇BMI、麻醉感觉平面阻滞范围及麻醉开始前5min(T0)和麻醉开始后5min (T1)血流动力学参数[收缩压(SBP)、舒张压(DBP)及心率(HR)]。结果：在相同剂量的麻醉药物下,B组产妇感觉平面阻滞范围高于A组产妇(P<0.05)；在T0时间点,A组产妇与B组间比较,SBP、DBP及HR无明显差异(P>0.05)；在T1时间点,A组与B组产妇间比较,SBP、DBP及HR差异有统计学意义(P<0.05)；在组内比较T1与T0比较,A组产妇SBP、DBP差异有统计学意义(P<0.05),HR无明显差异(P>0.05),B组产妇BP、DBP及HR差异有统计学意义(P<0.01)。结论：与正常体重的产妇相比较,肥胖产妇剖宫产手术行腰硬联合麻醉时更应关注麻醉阻滞范围及血流动力学变化。