单点法和两点法腰硬膜联合麻醉在剖宫产中麻醉和术后镇痛效果的比较

目的 观察比较单点法和两点法腰硬膜联合麻醉 （CSEA）在剖宫产术中的麻醉和术后镇痛的效果.方法 将120例剖宫产术患者随机分为两组,单点法组（A组）：L3～4 CSEA ＋硬膜外术后镇痛,其中需硬膜外补充麻醉的患者归为A1亚组;两点法组（B组）：L3～4单次腰麻联合T12-L1硬膜外麻醉＋硬膜外术后镇痛,其中需硬膜外补充麻醉的患者归为B1亚组.观察麻醉和术后镇痛效果,记录术后肛门排气的时间.结果 两组间腰麻效果差异无统计学意义; 两组需硬膜外麻醉的A1和B1组间比较,硬膜外麻醉后的最高感觉阻滞平面差异无统计学意义;但B1组达最高感觉阻滞平面所需局麻药量少、时间短、下肢最大运动阻滞Bromage评分低（P＜0.05）;术后镇痛A、B两组间比较,B组术后8～48h时视觉模拟镇痛评分低、术后24h下肢运动阻滞Bromage评分低、术后肛门排气时间早（P＜0.05）.结论 剖宫产术两点法CSEA能减少硬膜外局麻药的使用量,硬膜外麻醉起效快,改善术后硬膜外镇痛效果,减轻硬膜外镇痛引起的下肢运动阻滞,促进肠蠕动.

Comparison of analgesic effect of single-segment with double-segment technique in combination of spinal and epidural anesthesia for cesarean section

Objective To compare the analgesic effect of single-segment with doublesegment technique in combination of spinal and epidural anesthesia （CESA） for cesarean section. Methods One hundred and twenty cases of pregnancy scheduled for caesarean section were randomly allocated to one of two groups：patients in single-segment technique group （＇group A） received CESA performed at L34 interval, and patients who need additional epidural anesthesia were assigned in subgroup A1. Patients in double-segment technique group （group B） received spinal anesthesia performed at L3-4 interval combined with epiclural anesthesia through T12-L1 interval, and patients who need additional epidural anesthesia were assigned in subgroup B1. Both groups received epidural postoperative analgesia. The quality of spinal and epidural anesthesia and quality of epidural postoper- ative analgesia were observed respectively. Anal exhaust were also observed. Results There was no difference in quality of spinal anesthesia between group A and B. There was no significant difference in the upper level of sensory block between subgroup A1 and B1 after additional epidural anesthesia. But patients in subgroup B1 needed less epidural supplementary dosage and shorter time to achieve the demanded upper level of sensory block after additional epidural anesthesia, at the same time they had lower Bromage score of motor block in lower limbs than those in subgroup A1 （P〈 0.05 ）. The visual analog scale （VAS） scores of analgesia in group B at 8h,12h,24h,36h and 48h after operation and the Bromage score of motor block in lower limbs at 24h after operation were significantly lower compared with those in group A（P〈 0.05）. The anal exhaust time in group B were earlier than that in group A （P 〈 0.05）. Conclusion For caesarean section, CSEA with double-segment technique can provide satisfactory quality of anesthesia with less dosage of epidural supplementary anesthetics and shorter onset time. Postoperative epidural analgesia can improve satisfactory percentage of analgesia and relieve the motor block in lower limbs and reduce side effects.