基层医院剖宫产术中腰麻联合硬膜外麻醉的应用

目的:比较单纯硬膜外麻醉(EA)与腰麻联合硬膜外麻醉(CSEA)在基层医院剖宫手术中的应用效果。方法:选择ASA分级Ⅰ~Ⅱ级,单胎足月初产妇72例,随机分成两组,每组36例,EA组连续硬膜外麻醉,CSEA组腰麻联合硬膜外麻醉。比较两组产妇的麻醉起效时间、麻醉至胎儿娩出时间、手术时间、麻醉效果、术中血流动力学变化、新生儿A-pgar评分及围手术期不良反应发生情况。结果:EA组麻醉起效时间、麻醉至胎儿娩出时间、手术时间均长于CSEA组(P<0.05或P<0.01),CSEA组麻醉效果明显优于EA组(P<0.05),但低血压发生率较EA组高(P<0.05),两组血流动力学、新生儿A-pgar评分及围手术期不良反应比较差异无统计学意义(P>0.05)。结论:CSEA比EA起效快,效果确切,肌肉松弛良好是基层医院产妇剖宫产安全有效的麻醉方法。

Application of combined spinal-epidural anesthesia in primary hospital with cesarean section

Objective：To compare the application of epidural anesthesia（EA） and combined spinal-epidural anesthesia（CSEA） in cesarean section.Methods： 72 cases cesarean section with ASA Ⅰ~Ⅱ grade single-fetus mature pregnant women were randomly divided into two groups.Group EA（n=36） received epidural anesthesia,and group CSEA（n=36） received combined spinal-epidural anesthesia.The onset time,sensory nerve complete block time and the quality of anesthesia,the hemodynamic parameters,A-pgar score of fetus were delivered.The complications and adverse reactions of anesthesia were compared between two groups.Results： Compared with group CSEA,the onset time and sensory nerve complete block time of was significantly longer than that in group EA（P0.05 or P0.01）,the anesthesia effect was significantly better in group CSEA（P0.05）;No significant differences were observed in hemodynamic changes,A-pgar scores differences,incidence of complications and adverse reactions（P0.05）.Conclusion： CSEA is a reliable technique which provides more rapid onset of analgesia,and positive muscle relaxation results,it is an ideal anesthesia method for cesarean section in primary hospital.