摘要
目的观察妊娠高血压综合征(PIH)剖宫产孕妇腰硬联合麻醉(CSEA)中罗哌卡因、布比卡因应用效果及对孕妇血流动力学、新生儿Apgar评分影响。方法按组间匹配的原则,将2019-01-01-2021-01-01巨野县人民医院收治的74例择期行剖宫产的PIH孕妇分为罗哌卡因组(观察组,n=37)和布比卡因组(对照组,n=37)。观察2组孕妇感觉阻滞、运动阻滞情况,记录2组孕妇麻醉前(T_(1))及麻醉5(T_(2))、10(T_(3))、20(T_(4))及30 min(T_(5))时血流动力学指标[心率(HR)、收缩压(SBP)、舒张压(DBP)]监测结果,记录术中不良反应情况,比较2组新生儿Apgar评分差异。结果观察组感觉阻滞起效时间(65.14±12.75)s、运动阻滞起效时间(147.59±28.47)s,均大于对照组的(57.58±11.43)s、(131.35±26.19)s,t值分别为2.686和2.554,P值分别为0.009和0.013;运动恢复时间(142.75±13.16)min、孕妇术中不良反应发生率8.11%,均小于对照组的(168.59±17.23)min(t=7.250,P<0.001)、29.73%(χ^(2)=5.638,P=0.018)。T_(1)~T_(5)时,HR、SBP、DBP组间(F=18.615、25.468、42.724)、时间点(F=245.963、354.216、289.071)及组间与时间点交互效应(F=58.427、60.747、97.538)比较,差异有统计学意义,均P<0.001。T_(2)~T_(5)时,观察组HR、SBP、DBP均较T_(1)时降低,且均大于同时间点对照组,均P<0.05。2组新生儿出生1、5 min时Apgar评分,差异无统计学意义,均P>0.05。结论相较于等剂量布比卡因,罗哌卡因用于PIH剖宫产CSEA孕妇运动恢复时间较短、血流动力学状态波动较小、术中不良反应率较低,对新生儿无不利影响,更具优势。
Objective To observe the application effect of ropivacaine and bupivacaine in combined spinal-epidural anesthesia(CSEA)on pregnant women with pregnancy-induced hypertension(PIH)undergoing cesarean section and effects on hemodynamics and neonatal Apgar score of pregnant women.Methods 74cases of pregnant women with PIH who underwent elective cesarean section admitted between January 1,2019and January 1,2021were divided into ropivacaine group(observation group,n=37)and bupivacaine group(control group,n=37)according to the principle of matching between groups.The sensory and motor blocks of the two groups were observed.The monitoring results of hemodynamic parameters[heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP)]in the two groups were recorded before anesthesia(T_(1))and after 5min(T_(2)),10min(T_(3)),20min(T_(4))and 30min(T_(5))of anesthesia.The adverse reactions during operation were recorded,and the neonatal Apgar score was compared between the two groups.Results The onset times of sensory and motor blocks in observation group were longer than those in control group[(65.14±12.75)s vs(57.58±11.43)s,(147.59±28.47)s vs(131.35±26.19)s,t=2.686,2.554,P=0.009,0.013],and the motor recovery time and incidence rate of adverse reactions during operation with(142.75±13.16)min and 8.11%were all shorter or lower than(168.59±17.23)min and 29.73%in control group(t=7.250,P<0.001;χ^(2)=5.638,P=0.018).At T1-T5,there were statistically significant differences in the between-groups effects(F=18.615,25.468,42.724),time-points effects(F=245.963,354.216,289.071)and interaction effects of between-groups and time-points(F=58.427,60.747,97.538)of HR,SBP and DBP(all P<0.001).At T_(2)-T_(5),the HR,SBP and DBP in observation group were lower than those at T_(1),and they were all greater than those in control group at the same time point(P<0.05).There was no significant difference in neonatal Apgar score between the two groups at 1min and 5min of birth(P>0.05).Conclusions Compared with isodose bupivacaine,ropivacaine in CSEA of pregnant women with cesarean section of PIH has shorter motor recovery time,smaller fluctuation in hemodynamic state and lower incidence rate of intraoperative adverse reactions.And it has no adverse effects on neonates,thus it is more advantageous.
作者
韩念平
徐艳冰
HAN Nian-ping;XU Yan-bing(Department of Anesthesiology,Juye County People's Hospital,Heze 274900,China;Department of Anesthesiology,Shandong Provincial Hospital,Heze 250021,China)
出处
《社区医学杂志》
CAS
2022年第6期325-328,共4页
Journal Of Community Medicine
基金
2016年度山东省医药卫生科技发展计划(2016WS0422)
关键词
罗哌卡因
布比卡因
腰硬联合麻醉
妊娠高血压综合征
剖宫产
ropivacaine
bupivacaine
combined spinal-epidural anesthesia
pregnancy-induced hypertension
cesarean section