不同穿刺间隙腰硬联合麻醉对剖宫产产妇血液动力学、牵拉反应及新生儿的影响

目的探讨不同穿刺间隙腰硬联合麻醉对剖宫产产妇血液动力学、牵拉反应及新生儿的影响。方法前瞻性选取2019年4月至2020年10月在亳州市中医院接受治疗的100例剖宫产产妇作为研究对象,随机分为观察组和对照组,每组50例。观察组经L2~3间隙进行腰硬联合麻醉,对照组经L3~4间隙穿刺进行腰硬联合麻醉,比较2组产妇麻醉效果、麻醉起效时间、感觉恢复时间、血液动力学指标、牵拉反应、胎儿娩出时间及新生儿Apgar评分。结果与对照组相比,观察组产妇的麻醉总有效率(74.0%vs. 92.0%)及新生儿娩出后5 min Apgar评分(9.61±0.29)分vs.(9.82±0.25)分]显著增加(P <0.05),产妇麻醉后感觉阻滞起效时间(8.08±0.55) min vs.(3.52±0.26) min]、运动阻滞起效时间(9.17±0.57) min vs.(4.88±0.80) min]、感觉恢复时间(18.67±2.27) min vs.(10.79±0.74)min]、心脏指数、加速度指数、左心做功、舒张压、收缩压、心率及心排血量显著降低,胎儿娩出时间(16.10±3.58) min vs.(11.13±1.60) min]明显较短,探查清理腹腔时产生的牵拉反应(5.48±2.46)分vs.(1.96±1.28)分]较弱,不良反应发生率较低(6.0%vs. 22.0%),差异均有统计学意义(均P <0.05)。结论于L2~3间隙对剖宫产产妇实施腰硬联合麻醉,其麻醉效果较好,对产妇血液动力学、牵拉反应及对新生儿的影响等均优于L3~4间隙穿刺。

Effects of combined spinal epidural anesthesia at different puncture intervals on hemodynamics,traction response and newborns in cesarean section

Objective To analyze the effects of combined spinal epidural anesthesia at different puncture intervals on hemodynamics,traction response and newborns in cesarean section. Methods From April 2019 to October 2020,100 cases of cesarean section puerpera in Bozhou Hospital of Traditional Chinese Medicine were selected as the research objects and randomly divided into observation group and control group,with 50 cases in each group. Observation group was anesthetized by L2 ~ 3 space puncture,and control group was anesthetized by L3 ~ 4 space puncture. The anesthetic effect,onset time,sensory recovery time,hemodynamics,traction reaction,fetal delivery time and neonatal Apgar score were compared between the two groups. Results Compared with the control group,the total effective rate of maternal anesthesia in the observation group(74. 0% vs. 92. 0%) and the Apgar score(9. 61 ± 0. 29 vs. 9. 82 ± 0. 25) of the newborn infant at 5 minutes after delivery were significantly increased(P < 0. 05);onset time of sensory block after maternal anesthesia(8. 08 ± 0. 55) min vs.(3. 52 ± 0. 26) min ],motor block onset time(9. 17 ± 0. 57 min vs. 4. 88 ± 0. 80 min),sensory recovery time(18. 67 ± 2. 27) min vs.(10. 79 ± 0. 74) min],the cardiac index,acceleration index,left ventricular work,diastolic blood pressure,systolic blood pressure,heart rate and cardiac output of the observation group were significantly lower than those of the control group,and fetal delivery time (16. 10 ± 3. 58) min vs.(11. 13 ± 1. 60) min ] were significantly shorter,the traction reaction (5. 48 ± 2. 46) points vs.(1. 96 ± 1. 28) points ] produced during the exploration of the abdominal cavity was weaker,and the incidence of adverse reactions was lower(6. 0% vs. 22. 0%),and the differences were statistically significant(all P < 0. 05).Conclusion Combined spinal-epidural anesthesia for cesarean parturients in the L2 ~ 3 space puncture has better anesthesia effects,and it has better effects on maternal hemorheology,traction response and neonatal effects than L3 ~ 4 space puncture.