硬膜外与腰-硬联合麻醉在剖宫产术中的应用

目的比较硬膜外麻醉（EA）和腰-硬联合麻醉（CSEA）在剖宫产术中循环系统及镇痛效果和不良反应的情况。方法随机选择60例ASAⅠ～Ⅱ级患者,均分为两组。Ⅰ组30例为单纯硬膜外麻醉组 Ⅱ组30例为腰-硬联合麻醉组。术中监测NIBP、HR、SPO2和术中镇痛效果及牵拉反应情况。结果两组患者术中血流动力学较平稳,BP均较麻醉前降低,但腰-硬联合组下降明显。Ⅱ组患者骶神经阻滞完善,术中未见恶心、呕吐等不良反应,Ⅰ组部分患者手术牵拉时诉疼痛,伴恶心、呕吐、鼓肠、腹肌紧张等内脏牵拉反应,P〈0.01。结论腰-硬联合麻醉起效快,肌松完善,不良反应小,是一种值得推广的麻醉方法。

Application of Epidural and Combined Spinal-epidural Anesthesia in Cesarean Section

Objective To compare the effects and the fluctuation circulatory system,and investigate the side effects of combined spinal-epidural anesthesia and the epidural anesthesia in hysterectomy.Methods 60 patients under-going elective ASA Ⅰ-Ⅱ section were prospectively randomized into two groups;group Ⅰ（n=30） received simple epidural anesthesia;group Ⅱ（n=30） received combined spinal-epidural anesthesia.NIBP,HR,SPO2 monitored during operation and the relieving of pain and the reaction to be drawn.Results Hemodynamic was relatively steady in two groups of patients,two groups of patients showed lower BP than pre-anesthesia,but group Ⅱ dropped obviously.Sacral nerve in patients of group Ⅱ was blocked perfectly,disgust and vomit was not observed in operation in this group.Some patients in group Ⅰfelt the pain while leading to be drawn in operation,disgust,vomit,drum intestines,abdominal muscle tense and visceralgia was observed in this group（P0.01）.Conclusion The result arised fast in combined spinal-epidural anesthesia.The bad reaction was few,it was better than the simple epidural anesthesia,and was worth popularizing.