剖宫产手术中EA和CSEA麻醉方式的应用比较

目的观察剖宫产手术中EA和CSEA麻醉方式的效果，探讨剖宫产手术的较佳麻醉方法。方法回顾性分析比较我院2007年单纯硬膜外麻醉（EA，对照组）剖宫产270例与选择腰麻-硬膜外联合麻醉（CSEA，观察组）610产妇的临床资料。结果两组产妇均无呼吸抑制，血氧饱和度均大于95％，顺利完成手术，新生儿结局1min和5min Apgar评分均大于8．5，比较无差异（P〉0．05）：观察组Bromage高、麻醉显效时间短于、不良反应及PDPH发生率低于对照组，肌松程度好，但低血压高于观察组（P〈0．05）．对通过补充血容量，加大手术床左侧的倾斜度，应用升压药均可以纠正。结论CSE和EA均能够满足剖宫产手术的要求顺利完成手术．但CSEA具起效快、麻醉平面易于控制、肌松完全、术后并发症少等优点，可作为剖宫产术的首选麻醉方法．特别适合于急症胎儿宫内窘迫的产妇．

Comparison between EA and CSEA Anesthesia on Cesarean Section Surgery

Objective To investigate the effect of EA and CSEA anesthesia on cesarean section surgery, and explore the better methods of anesthesia. Methods Retrospective analysis of the clinical data of pure epidural anesthesia （EA, the control group） with 270 cases and section spinal anesthesia choice - epidural anesthesia （CSEA, the observation group） with 610 cases in our hospital in 2007. Results Two groups of women had no respiratory depression;oxygen saturation was more than 95%,and the operation was successful.Neonatal conclusion＇s lmin and 5min Apgar score was more than 8.5,and there was no difference in the two guoup（P〉 0.05）;Campared with the control group,Bromage was higher, narcotic effect was shorter, adverse reactions and the incidence of PDPH were lower in the observation group;but its low blood pressure was higher than the observation group （P 〈0.05）.Both of the two group＇s low blood pressure can be corrected by adding the blood volume, increasing the tilt of the left surgery bed and applicating the drugs that promoted blood pressure. Conclusion CSE and EA are able to meet the requirements of section surgery successful, but CSEA has the merits such as quick effect, easy-to-control plane anesthesia, muscle completely, and less post-operative complications so than it can be used as the preferred method of anesthesia and be particularly suitable for emergency maternal fetal distress.