针刺对剖宫产手术蛛网膜下腔阻滞麻醉效果的影响

目的评价针刺对剖宫产手术蛛网膜下腔阻滞麻醉效果的影响。方法将ASAⅠ级的90例择期行剖宫产手术的产妇,随机分为观察A组、观察B组、对照组,每组30例。各组均行蛛网膜下腔阻滞麻醉,对照组给予常规剂量麻醉药,观察A组给予针刺加常规剂量麻醉药,观察B组给予针刺加70%常规剂量的麻醉药;分别于入室后(T0)、麻醉前(T1)、麻醉后5 min(T2)、取出胎儿时(T3)、术毕(T4)检测平均动脉压(MAP)情况,统计各组麻黄素应用情况、新生儿出生时Apgar评分及术毕产妇疼痛VAS评分。结果①组内比较,观察A组、观察B组各时点MAP差异均无统计学意义(P0.05),对照组麻醉后5 min(T2)、取出胎儿时(T3)较入室时(T0)下降(P0.05);组间比较,取出胎儿时(T3)时,观察B组MAP高于观察A组和对照组(P0.05)。②对照组麻黄素使用率最高(33.33%),观察B组麻黄素使用率最低(6.70%);观察B组麻黄素使用率显著低于观察A组(16.67%)及对照组(33.33%)(P0.05),观察A组(16.67%)低于对照组(33.33%)(P0.05)。③组间比较,产妇VAS评分差异有统计学意义(P0.05),新生儿Apgar评分差异无统计学意义(P0.05)。结论针刺加蛛网膜下腔阻滞麻醉用于剖宫产手术,对产妇和胎儿均安全;其中正常麻醉药剂量的产妇血压平稳,镇痛效果确切;麻醉药减量30%的产妇血压更平稳,但镇痛效果个体差异较大。

Effect of acupuncture on cesarean section with subarachnoid space block anesthesia

Objective To evaluate the anesthetic effect of acupuncture on cesarean section with subarachnoid space block anesthesia. Methods Ninety ASA Grade I parturients were randomized into observation A group, observation B group and control group, with 30 cases in each group. All the parturients underwent subarachnoid block anesthesia. Cases in A group and control group were added with routine dose of anesthetic respectively, and cases in B group were added with 70% routine dose of anesthetic. We detected the blood pressure at TO, TI, T2, T3 and T4 to record the application of ephedrine, Apga score and VAS score in each group. Results ① No significant difference was found in MAP at different time points in A group or B group （ P 〉0.05 ） ; compared with MAP at TO, the MAP at T2 and T3 in control group were reduced （ P 〈0.05 ） ; the MAP at T3 in B group was higher than those of the A group and control group （P 〈0.05 ）.② The usage rate of ephedrine in control group was highest （33.33%）, and the B group was lowest （6.70%） ; the usage rate of ephedrine in B group was lower than that of the A group （16.67%） and control group significantly （P 〈0.05）; with significant difference between A group and control group （P 〈0.05 ）. ③There were significant difference in VAS score among the groups （P 〈0.05）, while without significant difference in Apgar score （P 〉0.05）. Conclusion Acupuncture and subarachnoid anesthesia is safe for parturient and fetus; the blood pressure of parturients underwent routine dose of anesthetic is stable and with certain analgesic effect; blood pressure of parturients underwent 70% routine dose of anesthetic is more stable, but with individual differences in analgesic effect.