腰麻与硬膜外麻醉对剖宫产麻醉效果及安全性比较

目的:比较腰麻和硬膜外麻醉对剖宫产手术的麻醉效果及安全性。方法:ASAⅠ级剖宫产46例,随机分腰麻组(CS)和硬膜外麻醉组(EA),每组各23例。CS组用重比重1.5％盐酸利多卡因,EA组用1.5％盐酸利多因。分别入手术室(T_0)、切皮(T_1)、胎儿娩出(T_2)、手术结束(T_3)时,多功能监护仪监测产妇平均动脉压(MBP)、心率(HR)等生命体征及脉搏氧饱和度(sPO_2),同时抽产妇静脉血及新生儿脐静脉血(T_2)测血糖(Glu)及去甲肾上腺素(NE)浓度;评定麻醉效果;记录注射局麻药至胎儿娩出时间(I-D)、子宫切开至胎儿娩出时间(U-D)及新生儿娩出1min及5min的Apgar评分。结果:整个过程产妇MBP、HR、sPO_2,无明显变化;CS组麻醉起效时间、I-D、U-D短(P<0.01)、麻醉及肌松效果比EA组好。两组产妇T_1、T_2、T_3的NE、Glu均比T_0低(P<0.01或P<0.05),T2时EA组高于CS组(P<0.05);两组胎儿脐静脉内Glu、NE无差异。两组新生儿Apgar评分差异无显著性(P>0.05)。结论:两种麻醉均可抑制产妇应激反应,CS更明显,对新生儿无不良抑制;只要应用得当,两者均安全有效,CS效果更好。

Comparison of Effect and Safety during Spinal Anaesthesia and Epidural Anaesthesia for Cesarean Section

Objective: To assess the effect and safety betweer spinal anaethesia and epidural anaethesia for caesarean section. Methods:Forty - six parients (ASA grade Ⅰ) were randomly divided into two groups : spinal group (CS, n = 23) , epidurral group (EA, n = 23). 2mL of 1.5% hyperbaric hydrochloric lidocaine was given in CS group; 13 - 16mL of 1.5% hydrochloric lidocaine was administrated in EA group. Mean arterial press (MAP)、heart rate (HR) and satisfy degree of puls oxygen (sPO2) were measured at coming - in the operation room (T0)##immediately after skin incision (T1)、at delivery (T2) and the end of surgery (T3) , also the blood samples were taken from maternal peripheral vein and umbilical vein for determination of plasma sugar ( Glu) and nore-pinephrie (ME) cocentratiomn . The anaethesia effect ..the duration between the induction of spinal or epidual block or and delivery (I - D), the duration between the uterus incision and delivery (U - D) and Apgar score of the neonate at 1 and 5 min after birth were recorded . Results:In whole course, marked change didn' t happen at maternal MAP、HR、sPO2 in every group .There was no significandy different in Apgar scores of the neonates and the cocentratiomn of umbilical vein plasma NE and Glu between the two groups ( P > 0.05) . In CS group , the block is faster in onset -, the I - D and U - D was significantly shorter ( P < 0.01) , the anaethesia effect was better . Maternal plasma NE and Glu at T1、T2、T3 were significantly lower than those at T0 in the both groups ( P <0.01 or P<0.05) . They were higher at T2 in EA group than in CS group (P<0.05) . Conclusion: Both of the two techniques can inhibit stress response of parturients to cesarean sections , it is greater in CS group than in EA group. They have no adverse effcts to neonates and are safe and efficient when applied in proper management. CS has better efficacy than EA.