全麻和腰麻在重度子痫前期剖宫产术中的比较

目的 探讨不同麻醉方式对重度子痫前期患者剖宫产术及母婴安全的影响因素.方法 通过对57例重度子痫前期患者剖宫产术全麻和腰麻的资料进行回顾性分析,根据麻醉方式分为全麻组(n=31)和腰麻组(n=26),比较两组手术开始时间、术中平均动脉压波动的峰值、新生儿Apgar评分、麻黄素用量等指标.结果 腰麻组产妇麻醉开始时间明显短于全麻组(t=2.15,P<0.01),平均动脉压的最低峰值低于全麻组(t=1.76,P<0.05),麻黄素的应用比例高于全麻组(χ2=6.90,P<0.01),麻黄素的用量高于全麻组(t=2.58,P<0.01).两组新生儿Apgar评分相比,差别无统计学意义.结论 全麻和腰麻用于重度子痫前期患者剖宫产手术中均是安全的,而对急诊剖宫产术应首选全麻.

Comparison of anesthetic effects of lumbar anesthesia and general anesthesia in cesarean section of women with severe preeclampsia

Objective To investigate influences of different anesthetizing methods on safety of mother and neonate in cesarean section for women with severe preeclampsia. Methods The data of lumbar anesthesia and general anesthesia in cesarean section of 57 women with severe preeclampsia were analyzed retrospectively. 31 women who underwent general anesthesia for cesarean section were allocated to general anesthesia group and 26 women who underwent lumbar anesthesia were allocated to lumbar anesthesia group. Severe preeclampsia was defined as 160 mm Hg or above of systolic pressure or 110 mmHg or above of diastolic pressure . The time from beginning of anesthesia to beginning of operation, the highest and the lowest mean arterial blood pressure (MAP) of women in the operation, total dose of ephedrine used during the operation and Apgar scores of the neonate at 1 min and 5 min after birth in the two groups were compared. Results In the lumbar anesthesia group, the time from beginning of anesthesia to beginning of operation was shorter than that in the general anesthesia group (t=2.15,P<0.01) and the lowest MAP during operation was also significantly less than that in the general anesthesia group(t=1.76,P<0.01). While proportion of women who were given ephedrine and the total dose of ephedrine during the operation in the lumbar anesthesia group were both higher than those in the general anesthesia group(χ2=6.90, P<0.01; t=2.58,P<0.01). In Apgar scores of the neonates, there were no significant difference between two groups (P>0.05). Conclusion Both general anesthesia and lumbar anesthesia are safe for those pregnant women with severe preeclampsia undergoing cesarean section,however, general anesthesia is better choice for emergent cesarean section.