头高位等比重腰-硬联合麻醉在重度子痫前期剖宫产术中的应用

目的：探讨头高位等比重腰-硬联合麻醉（CSEA）应用于重度子痫前期剖宫产术的效果。方法将120例重度子痫前期患者随机分为CSEA组和硬膜外阻滞（EA）组各60例。CSEA组采用头高15＆#176;左侧卧位，于L2～3穿刺蛛网膜注入等比重布比卡因7.5 mg行蛛网膜下隙阻滞（腰麻）；其后置钢丝硬膜外导管于硬膜外腔行EA。EA组只行EA。观察两组麻醉起效时间、麻醉后3 min麻醉平面、切皮时麻醉平面、新生儿Apgar评分、麻醉效果、血流动力学变化、不良反应等。结果 CSEA组麻醉起效时间、麻醉平面出现时间均快于EA组（P＜0.01），麻醉效果优于EA组（P＜0.01）。两组新生儿Apgar评分以及麻醉后的血压、心电图、血氧饱和度（SPO2）、心率比较差异无统计学意义（P＞0.05）。两组心动过缓、呼吸困难、神经并发症等不良反应比较差异无统计学意义（P＞0.05）。结论头高位等比重CSEA应用于重度子痫前期剖宫产术，麻醉起效快，血流动力学较稳定，母婴安全，比单用EA效果好。

Application of head high isobaric combined spinal epidural anesthesia in cesarean section of severe pre-eclampsia

Objective To explore the effect of head high isobaric combined spinal and epidural anes-thesia （CSEA）in cesarean section of severe preeclampsia. Methods One hundred and twenty cases of se-vere preeclampsia patients were randomly divided into CSEA group （60 cases）and EA group （60 cases）. In-travenous drip infusion of Ringer＆#39;s solution and 300~500 ml hydroxyethyl starch were administered to all pa-tients before anesthesia. The patients in CSEA group firstly received spinal anesthesia,took head up 1 5 ＆#176;and left lateral position,received L2~3 puncture injection spinal anesthesia with 7.5 mg isobaric bupivacaine,and then received wire epidural catheter in dural cavity,5 ~8 ml 2% lidocaine 3 ml and 0.8% ropivacaine were injected on-demand. The patients in EA group took left lateral position,received L2~3 puncture injection and epidural anesthesia,1 5 ~1 8 ml 2%lidocaine 3 ml and 0.8%ropivacaine were dividedly injected. Onset time of anesthesia,anesthesia of 3 minutes after spinal anesthesia,anesthesia when cutting leather,neonatal Apgar score,anesthetic effect,hemodynamic changes and adverse reaction were observed and compared between two groups. Results Onset time of anesthesia and anesthesia emergence time of CSEA group were significantly faster than EA group＇s （P〈0.01 ）. Anesthesia effect of CSEA group was better than EA group＇s （P〈0.01 ）.Neonatal Apgar score and blood pressure,ECG,SPO2 ,heart rate after anesthesia of two groups showed no statistical significance between two groups （P〉0.05 ）. Adverse reaction of two groups showed no statistical significance （P〉0.05 ）. Conclusions Compare with EA,head high isobaric CSEA has good effect in cesar-ean section of severe preeclampsia,and it is safe.