不同穿刺部位对腰椎-硬膜外腔阻滞联合麻醉效果的影响

目的 比较不同穿刺部位对腰椎-硬膜外腔阻滞联合麻醉用于剖宫产术的麻醉效果.方法 110例ASA分级Ⅰ～Ⅱ级的产妇,按照随机数字表法分为两组（Ⅰ组和Ⅱ组各55例）,Ⅰ组腰椎穿刺点为L2-3间隙;Ⅱ组腰椎穿刺点为L3-4间隙,两组均在腰椎-硬膜外腔阻滞联合麻醉下行剖宫产术,比较两组麻醉起效时间、新生儿出生后1 min 的Apgar评分、麻醉前后的平均动脉血压（MAP）变化、心率、需调整手术床位的例数、手术开始时的麻醉平面、需要硬膜外腔追加用药的例数、麻醉期间低血压及呼吸困难发生率、术中恶心呕吐等不良反应的发生情况.结果 两组患者均顺利完成手术,术后产妇、新生儿均未发生并发症.麻醉前后15 min MAP、心率、起效时间及1min新生儿Apgar评分等差异均无统计学意义（均P＞0.05）;Ⅱ组需要调整手术床位的例数（18例）、硬膜外用药的例数（7例）明显高于I组（2例、1例,x2=14.7、11.5,均P＜0.01）;Ⅱ组发生恶心、呼吸困难及低血压等不良反应发生率（16.4%、20.0%、1.8%）明显低于Ⅰ组（38.2%、47.3%、25.5%,x2=12.5、14.8、18.4,均P＜0.01）.结论 在剖宫产手术中,腰椎-硬膜外腔阻滞联合麻醉选择L3-4穿刺,可降低麻醉引起的恶心、呕吐、低血压等不良反应发生率,顺利完成剖宫产手术.

Influence of different puncture gap on the anesthesia effect in cesarean section with waist epidural anesthesia

Objective To compame the lumbar hemp-epidural block anesthesia choose different combination puncture point in pregnancy on laboratory intraoperative anesthetic effect.Methods 110 maternals classified for ASA Ⅰ～Ⅱof lactation,according to random number tables were divided into two groups,Ⅰ group lumbar puncture points for L2-3 clearance,Ⅱ group of lumbar puncture points to L3-4 clearance.Both groups the waist hemp-epidural joint block anesthesia downlink cesarean section,and two sets of anesthesia effect-acting period,after the baby born of 1 min Apgar score before anesthesia,the average arterial blood pressure(MAP)change,the lowest rate,adjust the number,surgical operation bed at the start of the plane,need anesthesia epidural anesthesia,medication found during hypotension and breathing difficulties incidence,intraoperative nausea and vomiting adverse events were compared.Results The operations of the two groups were successful,and there were no complications in postoperation maternal and newborn.Difficulty breathing rate,hypotension incidence,the incidence of nausea and vomiting were obviously higher than Ⅱ groups was statistically significant lying-in woman,difference(2 cases,1 case,x2=14.7,11.5,all P＜0.01).Need to adjust surgery beds in the number,epidural drugs significantly higher than the average Ⅱ group Ⅰ group(38.2%,47.3%,25.5%,x2=12.5,14.8,18.4,all P＜0.01).Conclusion In cesarean section in the operation,lumbar hemp-epidural joint block anesthesia choose L3-4 puncture,can reduce anesthesia cause nausea,vomiting hypotension,spinal cord injury and taper adverse reactions such as the incidence,in safer surgery under general anesthesia successfully completed cesarean section.