硬膜外麻醉自控镇痛对剖宫产产妇泌乳功能的影响

本文旨在探讨硬膜外病人自控镇痛 (ＰＣＥＡ)对剖宫产产妇泌乳功能的影响。1　资料与方法1 1　一般资料　选择采用硬膜外麻醉下行剖宫产术的初产妇 12 0例。均无严重的产科并发症、内分泌疾病及乳房发育缺陷。年龄 2 1～ 36岁 ,平均 2 5岁 ;体重 (6 4 0± 5 0 )ｋｇ ;孕周 38～ 42周。 12 0例随机分为两组 ,每组 6 0例 ,两组年龄、体征、孕周均无明显差异 (Ｐ >0 0 5 )。1 2　研究方法　镇痛组采用美国Ｂａｘｔｅｒ公司生产的Ⅱ型恒注镇痛泵 ,镇痛液由吗啡 2ｍｇ加 0 12 5 %布比卡因 6 0ｍｌ组成 ,术毕保留硬膜外导管 ,与镇痛泵连接 ,一…     

剖宫产术后硬膜外注射吗啡产妇哺乳对新生儿的影响

目的 探讨吗啡术后镇痛对产妇及哺乳新生儿的影响。方法 选择剖宫产术的产妇６０例,分为实验组和对照组,均采用连续硬膜外麻醉,麻醉药为２％利多卡因,在手术结束时,实验组注入吗啡２ｍｇ。采集新生儿和产妇的尿样,用荧光偏振免疫法（ＦＰＡ）测定尿液中吗啡有代谢产物。结果 ９６．６％镇痛效果明显Ｐ〈０．０５,实验组和对照组的新生儿和产妇的呼吸、心率、血压变化比较Ｐ〉０．０５。测定产妇尿样９６．７％阳性,新生称     

麻醉及剖宫产术对心脏病产妇心功能的影响

血液流动造成身体某一节段的容积变化,而容积的变化有其相应的电阻抗变化,记录此种阻抗变化,即可间接推测血流情况。在心动周期中,随心脏舒缩活动而引起的血液动力学变化势必反映在组织的电阻抗变化上,心阻抗图（ICG）是一种判断心脏功能,反映心脏血液动力学变化的天创伤     

硬膜外麻醉剖宫产术中输注佳乐施对胎儿氧供的影响

目的：估计硬膜外剖宫产术中输佳乐施（血定安）对胎儿氧运输的效力，以增加胎儿氧供及母体循环稳定。方法：采用随机对照方法，对４８例择期剖宫产产妇分别输注佳乐施（Ｇ组，ｎ＝２４）和林格氏液（Ｒ组，ｎ＝２４）进行临床观察。结果：输注佳乐施后母体血液稀释，Ｐ＜０．０１；Ｈｃｔ由０．３５６±０．０５４下降至０２５９±０．０３９，Ｐ＜０．０１；动脉血氧含量（ＣａＯ２）降低Ｐ＜０．０５；胎儿脐静脉血ｐＨ、ＰｖＯ２、ＳｖＯ２、ＣｖＯ２、脐动脉血ＰａＯ２显著高于输林格氏液者（Ｐ值分别为＜０．０５，＜０．０５，＜０．０１，＜０．０１，＜０．０５）。结论：佳乐施组胎儿氧供、氧耗都增加，但氧供的增加超过氧耗的增加，胎儿无血液稀释作用。提示：硬膜外麻醉剖宫产术中输注佳乐施能改善胎儿体内代谢状态，并能增加氧储，提高胎儿对麻醉及手术期间缺氧的耐受力。     

不同麻醉方式下妇科腹腔镜手术气腹、体位对呼吸功能的影响

目的探讨不同麻醉方式下妇科腹腔镜手术气腹和体位对呼吸功能的影响.方法妇科腹腔镜手术的患者40例,随机分成硬膜外麻醉组和全麻组各20例.均为ASA Ⅰ级.术中维持气腹压1.6kPa、20°T位.结果EA组气腹及T位后VT、MV增加,PETCO2高于GA组,SpO2比GA组低.GA组气腹后PPEAK增加;C下降;T位后PPEAK进一步增加.EA组T位后动脉血pH值(＜7.350)比GA组低,气腹及T位后PaCO2明显高于GA组.结论妇科腹腔镜手术气腹、体位使肺顺应性下降,肺有效通气量明显降低,EA下有发生呼吸性酸血症和低氧血症的趋势;采用GA能避免CO2蓄积,安全性高.     

全身麻醉对剖宫产产妇分娩新生儿的影响

目的探讨剖宫产产妇实施全身麻醉对新生儿的影响。方法选择全身麻醉或硬膜外阻滞下行择期剖宫产产妇各20例,分别组成全身麻醉组和硬膜外阻滞组。全身麻醉组产妇先后静脉注射芬太尼每公斤体重2·0μg、异丙酚每公斤体重1·5mg及维库溴胺每公斤体重0·08mg,并给予气管插管。胎儿娩出前给予笑气吸入(笑气∶氧气为1∶1)。硬膜外阻滞组产妇应用1·73%碳酸利多卡因5ml(含1∶200000肾上腺素)椎管内注入。两组分别于胎儿娩出后30min抽取新生儿桡动脉血行血气分析,并记录两组新生儿出生后3~5d的新生儿神经行为评分(NBNA)。结果(1)血气分析:全身麻醉组新生儿pH值、二氧化碳分压(PaCO2)、氧分压(PO2)、氧饱和度(SPO2)及红细胞压积(Hct)分别为7·34±0·08、(40±11)mmHg(1mmHg=0·133kPa)、(73±17)mmHg、(96·8±1·0)%、(53±5)%;硬膜外阻滞组新生儿分别为7·35±0·05、(41±8)mmHg、(71±17)mmHg、(96·6±1·0)%、(54±6)%。(2)NBNA:全身麻醉组新生儿行为能力、被动肌张力、主动肌张力、原始反射、一般状态分别为(12·6±0·7)、(7·2±0·7)、(7·4±0·6)、(5·6±0·8)、(5·9±0·3)分。硬膜外阻滞组分别为(13·4±0·8)、(7·3±0·5)、(7·3±0·8)、(5·6±0·6)、(5·9±0·3)分。两组各项评分比较,差异均无统计学意义(P>0·05)。结论剖宫产产妇采用常规剂量药物实施全身麻醉对新生儿安全无明显影响。     

剖宫产术麻醉方法的选择及并发症的防治

剖宫产术对麻醉的要求是使产妇镇痛完善 ,对其生理功能影响小 ,对胎儿无明显抑制及其它不良影响。目前 ,尽管麻醉方法很多 ,但仍无一种各方面均能兼顾的理想方法。剖宫产术麻醉方法的选择应依据母儿情况 ,剖宫产的紧急程度 ,麻醉和复苏的设备条件以及麻醉医师技术情况而定。同时 ,积极防治麻醉并发症 ,对于保证母儿平安、手术顺利进行十分重要。1　剖宫产术麻醉方法的选择1 1　局部浸润麻醉与麻醉镇痛药联合应用　以安全有效剂量的局麻药 ,于产妇下腹部手术切口范围行棱形或扇形的皮下、筋膜以及腹膜的浸润麻醉。局麻药包括 :普鲁卡因、氯普…     

产时硬膜外麻醉镇痛与难产剖宫产

本文综述了在初产妇硬膜外麻醉产时镇痛对难产剖宫产的影响。迄今有研究提出硬麻镇痛增加初产妇难产剖宫产率。硬麻增加难产剖宫产率潜在的机理可能涉及多种因素，包括产次，给予硬麻时的宫颈扩张情况，硬麻的给药与处理技术以及硬麻镇痛后的产科处理。两项研究提示，延迟到宫口扩张５ｃｍ以上时使用硬麻可以减少剖宫产的危险怀。与麻醉药相比，硬麻镇痛是安全且较优越的产时镇痛方法。然而需告知初产妇，硬麻产时镇痛可增加难产剖宫     

腰麻、硬膜外麻醉及硬、腰联合麻醉在选择性剖宫产术中的应用比较

腰麻（ｓｕｂａｒａｃｈｎｏｉｄａｎａｌｇｅｓｉａ,ＳＡ）、硬膜外麻醉（ｅｐｉｄｕｒａｌａｎａｌｇｅｓｉａ,ＥＡ）是选择性剖宫产术常用的麻醉方法。１９８１年Ｂｒｏｗｎｒｉｄｇｅ［１］联合应用腰麻硬膜外麻醉（ｃｏｍｂｉｎｅｄｓｕｂａｒａｃｈｎｏｉｄａｎｄ...     

饱胃急诊剖宫产患者行腰硬联合麻醉的危险因素分析

目的分析饱胃患者急诊剖宫产行腰硬联合麻醉(CSEA)的危险因素。 方法选择2010年1月至2012年1月在广州医学院第三附属医院在CSEA下行ASA Ⅰ～Ⅱ级剖宫产手术的220例患者病例进行研究,其中饱胃急诊剖宫产136例为饱胃组,择期剖宫产84例为对照组。两组患者均采用CSEA。对饱胃组患者术中恶心、呕吐的相关因素进行偏相关分析,然后剔除两组术中使用卡前列素氨丁三醇注射液的病例后,再对术中不良事件和新生儿出生情况参数进行比较。 结果饱胃组患者中,与恶心存在偏相关关系的因素是术中使用卡前列素氨丁三醇注射液(r＝0.440)和术中发生低血压(r＝0.274);与呕吐存在偏相关关系的因素是术中使用卡前列素氨丁三醇注射液(r＝0.646)。饱胃组与对照组在剔除使用卡前列素氨丁三醇注射液的病例后比较,对照组术中低血压的发生率高于饱胃组( χ²＝20.455,P<0.05),两组其余指标的差异无统计学意义(P>0.05)。 结论术中使用卡前列素氨丁三醇注射液与低血压是饱胃患者在CSEA下行急诊剖宫产麻醉的危险因素。     

剖宫产术时两种麻醉方式的对比研究

目的通过对剖宫产术时全身麻醉与硬膜外阻滞的对比研究,探讨两种麻醉方式对胎儿的安全性。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<50×109 /L的病例行全身麻醉(全麻组),血小板≥50×109 /L者行硬膜外阻滞(硬膜外组),两组各30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。分别记录两组胎儿娩出时间、手术时间、1分钟和5分钟Apgar评分,并比较这些指标和血气分析指标。结果全麻组和硬膜外组新生儿1分钟Apgar评分分别为(9 5±1 1)、(9 8±0 7 )分, 5分钟Apgar评分均为10分,两组比较,差异均无统计学意义(P>0 05)。胎儿娩出时脐动、静脉血的pH值在全麻组分别为7 31±0 06和7 31±0 04,硬膜外组分别为7 28±0 07和7 32±0 05,两组比较,差异均无统计学意义(P>0 05)。结论全身麻醉和硬膜外阻滞均可安全地用于剖宫产。     

Comparison of neonatal effects of epidural and general anesthesia for cesarean section

We assessed the influence of anesthetic technique for cesarean section on neonatal outcome. Thirty parturient women (ASA I/II) were randomly allocated into two groups. In Group GA general anesthesia was induced with 4 mg.kg(-1) thiopental and 1.5 mg.kg(-1) succinylcholine. In group EA epidural anesthesia was performed with 20 ml 0.375% bupivacaine through L(3-4) inter-space. 1-min Apgar scores were significantly higher in group EA (p < 0.001). Neurologic and Adaptive Capacity scores at 2 and 24 h were higher in group EA (p < 0.001). In terms of blood gas values, umbilical arterial pH and pO(2) values were higher in group EA (p < 0.05 and p < 0.001, respectively). The first breast-feeding intervals were found to be shorter in group EA (p < 0.001). We conclude that in terms of better Apgar and NAC scores, acid-base status and earlier initiation of breast-feeding, the epidural anesthesia may be preferred to general anesthesia in cesarean section.     

Uterine and umbilical blood flow during cesarean section under epidural anesthesia

Umbilical and uterine blood flow velocity waveforms were studied in 22 women undergoing elective cesarean section under epidural anesthesia. The measurements were taken prior to initiation of anesthesia (baseline levels), after the appropriate level of anesthesia had been achieved (prior to the onset of surgery), and intraoperatively immediately prior to the uterine incision and after the delivery (uterine blood flow). Achievement of the therapeutic level of epidural anesthesia was not associated with altered umbilical and uterine blood flow. Intraoperatively, however, 2/3 of the women manifested increased resistance in the utero-fetal circuit, judging by the rise in S/D ratios. Under normal circumstances (absence of fetal distress and maternal complications prior to the cesarean section, adequate maternal hydration and oxygenation, etc.) these changes did not cause any neonatal compromise as evidenced by normal Apgar scores and freedom from complications during the neonatal period.     

Comparative evaluation of carticaine and bupivacaine in epidural anesthesia in cesarean section

Lumbar epidural anaesthesia with Carticain (Ultracain) has been applied in 25 Caesarean Sections. The resulting data (waiting period, effective length and quality of the analgesia, blood pressure drop, postoperative phase, newborn state, side effects) have been compared with those of Bupivacain (Marcain) used for the same purpose. Carticain is fitted for purposes of obstetrical anaesthesia, even more than Bupivacain, owing to its slighter blood-pressure diminishing effect, and shorter waiting period.     

Frequency cesarean section in pregnant women with uterine myoma

We were investigated in the connection of the frequency of cesarean sections at pregnant women with uterus myomatous and physiological pregnancies. 189 pregnant patients with myomas have been analyzed retrospectively 72 women with physiological pregnancies belong to the controlled group. Our results didn't confirm the higher risk of cesarean sections in analyzed group.     

The effect of continuous epidural analgesia on cesarean section for dystocia in nulliparous women

Epidural analgesia in labor is generally accepted as safe and effective and therefore has become increasingly popular. However, little is known regarding the effect of epidural analgesia on the incidence of cesarean section for dystocia in nulliparous women. During the first 6 months of 1987 we studied 711 consecutive nulliparous women at term, with cephalic fetal presentations and spontaneous onset of labor. Comparison of 447 patients who received epidural analgesia in labor with 264 patients who received either narcotics or no analgesia was performed. The incidence of cesarean section for dystocia was significantly greater (p less than 0.005) in the epidural group (10.3%) than in the nonepidural group (3.8%). There remained a significantly increased incidence (p less than 0.005) of cesarean section for dystocia in the epidural group after selection bias was corrected and the following confounding variables were controlled by multivariate analysis: maternal age, race, gestational age, cervical dilatation on admission, use of oxytocin, duration of oxytocin use, maximum infusion rate of oxytocin, duration of labor, presence of meconium, and birth weight. The incidence of cesarean section for fetal distress was similar (p greater than 0.20) in both groups. There were no clinically significant differences in frequency of low Apgar scores at 5 minutes or cord arterial and venous blood gas parameters between the two groups. This study suggests that epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparous women.     

Fetal acidosis, 2-chloroprocaine, and epidural anesthesia for cesarean section

Amide-linked local anesthetic agents, such as lidocaine and bupivacaine, can become "trapped" in their ionized forms on the fetal side of the placenta, and therefore their net transfer across the placenta is increased. An ester-linked local anesthetic agent, 2-chloroprocaine, is rapidly metabolized, and placental transfer is limited. Since the metabolism of 2-chloroprocaine by fetal plasma is slower than in maternal plasma, the potential for ion trapping exists. The purpose of this study was to determine the disposition of 2-chloroprocaine and its metabolite, chloroaminobenzoic acid, in relation to the umbilical cord vein pH at delivery, and specifically, to determine whether ion trapping exists. Epidural anesthesia with 2-chloroprocaine was administered to 44 women at term prior to cesarean section. At delivery the levels of 2-chloroprocaine and chloroaminobenzoic acid in maternal plasma and umbilical cord vein were quantitated. Neonates were divided into two groups based on the umbilical cord vein pH at delivery. Ten of the 44 patients delivered neonates with a pH less than or equal to 7.25 (acidotic group) while 34 delivered neonates with a pH greater than 7.25 (nonacidotic group). The mean umbilical cord vein pH in the acidotic and nonacidotic groups was 7.22 +/- 0.03 and 7.32 +/- 0.03, respectively (p less than 0.001). There were also no differences between the groups in maternal and neonatal clinical characteristics or in the total dose of 2-chloroprocaine administered or the drug-to-delivery interval. The pharmacologic results did not demonstrate a statistical difference in the concentration of 2-chloroprocaine or chloroaminobenzoic acid in the maternal vein or umbilical cord vein at delivery between the two groups. Thus the results of this study demonstrate that placental transfer of 2-chloroprocaine is not influenced by fetal acidosis. Therefore these data suggest that 2-chloroprocaine may be the drug of choice when fetal acidosis or distress is anticipated.