不同麻醉方式对妊娠高血压综合征剖宫产术产妇血液流变学的影响及意义

【目的】探讨不同麻醉方式对妊娠高血压综合征（PIH）剖宫产术产妇血液流变学的影响。【方法]92例PIH剖宫产妇随机分为腰麻一硬膜外联合阻滞（CSEA）组和硬膜外阻滞（EB）组，分别给予相应的麻醉方式。在入室平静后、麻醉起效后和胎儿娩出后分别对其患者进行血液流变学检测。并对新生儿进行1min和5rainApgar评分。【结果】两组患者在年龄，孕周，ASA分级等方面差异无统计学意义（P〉0．05）。麻醉前，两组全血低切粘度相似（P〉0．05）；麻醉生效时，两组患者的全血低切粘度均下降，低于麻醉前（P〈0．05），而CSEA组下降更明显（P〈0．05）；胎儿娩出时，两组的全血低切粘度较麻醉中没有明显改变，但仍较麻醉前低（P〈0．05），并且CSEA组的全血低切粘度仍要低于EB组（P〈0．05）。全血中切粘度、全血高切粘度和血浆粘度三个指标，均显示出和一样的改变趋势。两组新生儿1min和5minApgar评分CSEA组均较EB组稍高，但未见有统计学差异（P〉0．05）。【结论】腰麻-硬膜外联合阻滞较硬膜外阻滞均能改善妊娠高血压综合征剖宫产术产妇的血液流变学状态，但腰麻-硬膜外联合阻滞更明显，对母儿更为有利。

Influence of Different Anesthesia Approaches on Hemorheology in Patients with Pregnancy-induced Hypertension During Cesarean Section

Objective] To investigate the influence of different anesthesia approaches on hemorheology in pa tients with pregnancy-induced hypertension（PIH） during cesarean section. Methods] Totally 92 patients with PIH undergoing cesarean section were randomly divided into spinal-epidural anesthesia（CSEA） group and the epidural block（EB） group. The hemorheology after the burglary, at the onset of anesthesia and after labor were measured. Apgar scoring of newborns at 1min and 5min were performed. Results] There were no significant difference in the age, gestational age and ASA grade between two groups（ P〉0.05）. Before anesthesia, shear whole blood viscosity in two groups was similar（ P 〉0.05）. At the onset of anesthesia, shear whole blood viscosity in two group all decreased and was lower than that before anesthesia（ P 〈0.05）, while shear whole blood viscosity in CSEA group decreased more （ P 〈0.05）. After labor, shear whole blood viscosity in the two groups did not change significantly, hut was still lower than that before anesthesia（ P 〈0.05） , and shear whole blood viscosity in CSEA group was still lower than that in EB group（ P 〈0.05）. The three indicators shear whole blood viscosity, plasma viscosity and high shear viscosity showed the same changing trend. Neonatal lmin and 5rain Apgar score in CSEA group were higher than those in EB group, but there was no significant difference（ P 〉0. 05）. Conclusion]The spinal epidural or epidural anesthesia can improve hemorheology of patients with pregnancy induced hypertension during cesarean section, but the spinal-epidural anesthesia is more effective and favorable for the mother and children.