不同穿刺体位在腰-硬联合麻醉剖宫产术中的比较

目的比较不同穿刺体位在腰-硬联合麻醉(CSEA)剖宫产术中的效果。方法拟行剖宫产术的足月妊娠产妇90例,随机分为两组,每组45例。选择L3~4椎间隙作为穿刺点。R组右侧穿刺腰麻后保持穿刺体位2 min后左倾30°仰卧至手术开始,L组左侧穿刺腰麻后仰卧位,并调整手术床左倾30°直至手术开始。腰麻药物均为1.0%罗哌卡因1.5 ml+10%葡萄糖0.5 ml。观察腰麻药物注入后15 min内产妇感觉阻滞效应及不良反应情况,记录新生儿Apgar评分,检测脐动脉血p H值。结果 R组产妇最终阻滞平面明显低于L组,达到最终阻滞平面所需时间明显短于L组(P0.05)。R组麻黄碱用量为0(0~6)mg,明显低于L组的6(0~12)mg(P0.05)。R组脐动脉血p H值明显高于L组(P0.05)。两组新生儿Apgar评分差异无统计学意义。结论剖宫产术采用右侧卧位穿刺注药后保持穿刺体位2 min后30°仰卧,其麻醉效果优于左侧卧位穿刺后30°仰卧体位。

Comparison of different puncture positions for combined spinal-epidural anesthesia in cesarean section

Objective To compare the effect of different puncture positions in the combined spinal epidural anesthesia (CSEA)in cesarean section.Methods Ninety uterogestation women under-going elective Caesarean section were randomly divided into two groups,45 in each group.L3-4 inter-vertebral space was selected as puncture point.Group R kept right lateral position for two minutes af-ter puncture and turned 30°left tilt supine position until ready for surgery.Group L was turned to su-pine position after left lateral punctured and then turned to 30 left tilt supine position until ready for surgery.1% ropivacaine 1.5 ml+ 10% glucose 0.5 ml was used for spinal anesthesia.The sensory block level and adverse reaction within 1 5 min after the spinal anesthesia were observed,and the neo-natal Apgar score and the pH value of umbilical artery blood were recorded.Results The final block level of the group R was significantly lower than group L,and the time achieving final block height was significantly shorter than that in group L(P <0.05 ).The ephedrine dosage of group R 0 (0-6) mg was significantly lower than that of group L6 (0-12)mg (P <0.05).The PH value of umbilical artery blood in group R was significantly higher than that in group L (P <0.05).There was no sig-nificant difference in neonatal Apgar score.Conclusion In Cesarean section,keeping right lateral puncture position for two minutes after infusion and then turning 30° left tilt supine position can a-chieve better effects than 30°left tilt supine position immediately after puncturing.