腰硬联合麻醉和持续硬膜外麻醉应用于二次剖宫产术效果的评价

目的比较在二次剖宫产术中,腰硬联合麻醉(CSEA)和持续硬膜外麻醉(CEA)的效果。方法 80例择期行二次剖宫产术的产妇,随机分成CSEA组42例和CEA组38例。观察两组的麻醉起效时间、麻醉操作时间、记录罗哌卡因的用药总量。由手术医师对产妇腹壁肌松作出评价,记录产妇的运动阻滞的Bromage改良评分以及术中不良反应的发生情况。结果相对于CEA组,CSEA组麻醉起效时间明显缩短(t=18.91,P<0.05),罗哌卡因用量较小(t=27.14,P<0.05),手术医师对腹壁肌松满意度高(χ2=54.55,P<0.05),Bromage改良评分达到3级的例数也明显多于CEA组(χ2=125.98,P<0.05)。但CSEA操作较为复杂,耗时较长(t=3.75,P<0.05)。两组产妇发生低血压、血压下降、心动过缓、术后头痛等不良反应相比较,差异均无统计学意义(χ2分别=6.63、7.47、0.01、0.00,P均>0.05)。结论 CSEA用于二次剖宫产术,具有麻醉起效快,腹壁肌松好,手术医师满意程度高等优点,但操作稍复杂。

Comparison of combined spinal-epidural anesthesia and continuous epidural anesthesia in second cesarean section

Objective To evaluate the effect of combined spinal-epidural anesthesia and continuous epidural anesthesia applied to the parturients undergoing the second cesarean section. Methods Eighty patients were randomly assigned to groups which received combined spinal-epidural anesthesia （42 cases） or continuous epidural anesthesia（38 cases）.Anesthesia effects, complications, time of intrathecal puncturing, dosage of ropicaine, bromage scores were observed and recorded. Results There were no significant differences between the two groups in age, body weight and duration of operation. Compared with continuous epidural anesthesia, combined spinal-epidural anesthesia had the advantages of shorter onset time （t=18.91,P〈0.05）, lower consumption of ropicaine （t=27.14,P〈0.05） and better abdominal muscle relaxation （X^2=54.55,P〈0.05）.The puncturing of combined spinal-epidural anesthesia was more complicated than continuous epidural anesthesia and it took more time （t=3.75,P〈0.05）. Conclusions Combined spinal-epidural anesthesia had better anesthesia effect on parturients undergoing the second cesarean section than continuous epidural anesthesia with the advantages of lower consumption of local anesthetic, instant onset, better abdominal muscle relaxation. But the puncturing of combined spinal-epidural anesthesia is more complicated than that of the continuous epidural anesthesia.