硬膜外麻醉两种注药方法在剖宫产术中的效果比较

目的：比较两种注药方法在剖宫产术中的麻醉效果。方法选择ASA Ⅰ～Ⅱ级剖宫产术226例，采用随机数字表格法随机分为观察组和对照组各113例，观察组：硬膜外腔穿刺成功后针尖斜面向尾端注入1．7％碳酸利多卡因注射液5 mL，然后针尖斜面转向头端，观察3～5 min无全脊髓麻醉等异常情况再注入1．7％碳酸利多卡因注射液5 mL，之后置入硬膜外导管，改平卧位后继续注入1．7％碳酸利多卡因注射液5 mL。对照组：硬膜外腔穿刺成功后向头端置管按传统教学方法给药。记录两组产妇阻滞平面、术中疼痛强度及胎儿娩出时间，观察两组术中生命体征变化和胎儿娩出后Apgar评分。结果观察组麻醉阻滞平面为（14．43±1．21）、术中疼痛评分（1．61±0．92）分、胎儿娩出时间（1．8±0．6） min，均优于对照组（ t＝12.76、13.07、12．86，均P＜0．05）；两组间MAP、HR、R、SpO2差异均无统计学意义（ F＝4．32、2．73、3．54、3.06，均P＞0．05）；两组术中生命体征变化和新生儿Apgar评分差异均无统计学意义（均P＞0．05）。结论向硬膜外腔两端注药方法用于剖宫产术比传统给药方法具有更好的麻醉效果。

Comparison of effects of epidural anesthesia injection at both ends in the cesarean section

Objective To compare effects of both ends of the injection cesarean section anesthesia differ-ences.Methods ASAⅠ-Ⅱgrade cesarean section 226 cases were selected and randomly divided into the observa-tion group and control group on the basis of number characterization.Observation group：After the success of epidural puncture needle oblique injection of 1.7% for the end of lidocaine carbonate 5mL,then needle bevel steering head end 3-5min without observing all spinal abnormalities such as re-injection of 5mL of 1.7% lidocaine carbonate,fol-lowed by epidural catheter inserted,modified supine position to continue after injection of 1.7% lidocaine carbonate 5mL;Control group：after the success of epidural catheter tip administered by traditional teaching methods.Two groups of maternal range block plane , intraoperative pain intensity and time of delivery of the fetus were recorded .intraoperative changes in vital signs and Apgar score after the fetus were observed.Results The block wide range for anesthesia of the observation group[（14.43±1.21）points]were significantly higher than that of the control group,and intraopera-tive pain was （1.61 ±0.92）points,fetal childbirth lengthwas （1.8 ±0.6）minutes,which were better than those in the control group（t=12.76,13.07,12.86,all P〈0.05）;The MAP,HR,R,SpO2 between the two groups showed no significant differences（F=4.32,2.73,3.54,3.06,all P〈0.05）;Intraoperative vital signs and Apgar score was con-firmed no difference between the two groups（all P〉0.05）.Conclusion Both ends of the epidural injection for ce-sarean section is better than the traditional mode of administration of anesthesia.