腰-硬联合阻滞镇痛在合并妊娠期高血压疾病产妇中的应用

目的探讨腰-硬联合阻滞镇痛在合并妊娠期高血压疾病初产妇中应用的安全性和有效性。方法选取2012年1月至2015年12月山东单县东大医院收治的妊娠期高血压疾病患者175例,根据是否行腰-硬联合阻滞麻醉镇痛分为分娩镇痛组(105例)与对照组(70例)。两组采用相同的血压控制和产程管理方式,分娩镇痛组在宫口开大4 cm后实施腰-硬联合阻滞分娩镇痛。观察两组产妇的一般情况、待产和分娩过程中各时点平均动脉压、分娩情况、母婴并发症及治疗情况。结果与对照组相比,分娩镇痛组患者平均动脉压在活跃期后60 min[(103.7±5.7)mm Hg vs(118.2±5.5)mm Hg]、活跃期后120 min[(104.7±4.3)mm Hg vs(119.3±5.1)mm Hg]、第二产程时[(107.8±5.3)mm Hg vs(114.8±6.1)mm Hg]、产后120min[(98.2±5.9)mm Hg vs(103.8±6.7)mm Hg]各时点均较低(P0.05)。分娩镇痛组患者剖宫产率(19.0%)低于对照组(34.3%)(P0.05),第二产程时间较长(50.3±20.5)min vs(42.1±19.9)min、催产素使用率较高(60.0%vs 44.3%)(P0.05)。分娩镇痛组患者头痛头晕发生率(6.7%vs 18.6%)、加用降压药治疗率(12.4%vs 38.6%)均较对照组低(P0.05)。结论腰-硬联合阻滞镇痛可降低妊娠期高血压疾病初产妇的剖宫产率及母婴分娩后并发症的发生率,明显改善患者的分娩结局。

Application of combined spinal-epidural anesthesia and analgesia in patients with hypertension during pregnancy

Objective To explore the safety and effectiveness of combined spinal-epidural anesthesia ( CSEA) and analgesia in the application of patients with hypertension during pregnancy. Methods 175 patients with pregnancy-induced hypertension syndrome and preeclampsia treated in grand hospital of Shanxian County from January 2012 to December 2015 were selected. Patients were divided into labor analgesia group (105 cases) and control group (70 cases) according to whether accepted combined spinal-epidural anesthesia and analgesia. Patients in the two groups were given the same blood pressure control and production process management, and patients in labor analgesia group were treated by combined spinal-epidural anesthesia for labor analgesia after 4 cm. Observational index including the women 's general situation, average arterial pressure in labor and birth process at each time point, delivery, maternal and infant complications and treatment situation. Results Compared to control group, patients in labor analgesia group had lower average arterial pressure at 60 min[(103. 7 ± 5. 7)mmHg vs (118. 2 ± 5. 5)mmHg], 120 min after active period[(104. 7 ± 4.3)mmHg vs (119.3 ±5.1)mmHg], the second stage of labor[(107.8 ±5.3)mmHg vs (114.8 ±6.1)mmHg], postpartum 120 min[(98.2 ±5.9)mmHg vs (103.8 ±6.7)mmHg] (P<0.05). The cesarean section rate of patients in labor analgesia group was 19. 0 %, lower than that in control group (34. 3 %) (P<0. 05). Compared to control group, patients in labor analgesia group had longer time of second stage of labor[(50. 3 ± 20. 5)min vs (42. 1 ± 19. 9)min] and higher rate of oxytocin use(60. 0 % vs 44. 3 %) (P<0. 05). Compared to control group, patients in labor analgesia group had lower rate of headache(6. 7 % vs 18. 6 %) and dizziness and antihypertensive therapy(12. 4% vs 38. 6%)(P<0. 05). Conclusion CSEA analgesia can reduce the cesarean section rate of patients with pregnancy-induced hypertension syndrome and preeclampsia, reduce puerperal complications in moms and infants and significantly improve birth outcomes.