腰-硬联合麻醉在瘢痕子宫剖宫产术中应用效果观察

目的:比较腰-硬联合麻醉（CSEA）和连续硬膜外麻醉（CEA）在瘢痕子宫剖宫产手术中的效果。方法:选择择期瘢痕子宫剖宫产66例，随机分为CSEA组和CEA组各33例，观察2种方法的麻醉效果、不良反应、对产妇血流动力学和新生儿的影响。结果:与麻醉前比较，CSEA组麻醉后10 min无创动脉血压明显低于麻醉前（P<0.01），CEA组麻醉后20 min无创动脉血压显著低于麻醉前（P<0.01），CSEA组麻醉后10~30 min心率均明显升高（P<0.01），CEA组20~30 min心率也明显升高（P<0.01）。CSEA组的麻醉药用量、麻醉起效时间和麻醉阻滞完善时间均明显少于CEA组（P<0.01）。CSEA组麻醉效果优良率达100.0%，高于CEA组的84.9%（P<0.05）。结论:CSEA具有CEA和腰麻的双重优点，对于瘢痕子宫剖宫产手术能达到很满意的麻醉效果。

Effect of the combined spinal-epidural anesthesia and epidural anesthesia on cesarean section in scar uterine

Objective：To compare the effects of the combined spinal-epidural anesthesia（CSEA） and continuous epidural anesthesia （CEA） on cesarean section in scar uterine.Methods：Sixty-six elective caesarean patients with scar uterine were randomly divided into the CSEA group （33 cases） and CEA group （33 cases）.The anaesthetic effects,adverse reaction and effect of hemodynamics of parturient on neonate in two groups were observed.Results：Compared with before anesthesia,the noninvasive arteries pressure levels in CSEA group and CEA group were decreased significantly at 10 min and 20 min after anesthesia,respectively（P ＜0.01）.The levels of heart rate in CSEA group and CEA group were increased significantly at 10 to 30 min and 20 to 30 min after anesthesia,respectively （P ＜ 0.01）.The dosage,onset time and retardation time of anesthesia in CSEA group were significantly lower than those in CEA group （P ＜0.01）.The excellence ratio of anesthesia in CSEA group（100.0％） was higher than that in CEA group（84.9％） （P ＜0.05）.Conclusions：The CSEA has the dual advantages of CEA and lumbar anesthesia,which has good effect on cesarean section in scar uterine.