摘要
目的:分析腰硬联合阻滞麻醉对重度子痫前期剖宫产患者应激反应、血流动力学及母婴结局的影响。方法:回顾性收集本院2017年1月—2019年6月收治的115例重度子痫前期接受剖宫产患者资料,根据麻醉方式分为对照组(硬膜外麻醉)56例和联合组(腰硬联合阻滞麻醉)59例。对比两组患者围手术期间应激反应、血流动力学指标变化、麻醉效果、母婴结局、不良反应。结果:手术后两组应激指标水平均升高,但联合组手术后即刻、24h、48h应激指标水平均低于对照组(P<0.05)。麻醉平稳、手术开始、胎儿娩出、手术结束时,两组舒张压(SBP)、收缩压(DBP)均低于麻醉前,联合组胎儿娩出及手术结束时SBP、DBP值高于对照组(P<0.05);两组心率(HR)在麻醉平稳、手术开始、胎儿娩出时高于麻醉前,手术结束后低于麻醉前,且联合组胎儿分娩时低于对照组、手术结束时高于对照组(均P<0.05)。联合组麻醉起效时间(2.3±1.4 min)、最高阻滞水平时间(8.5±3.5 min)均低于对照组(6.3±1.5 min、16.3±3.2 min),麻黄碱用量(12.31±2.10 mg)高于对照组(7.55±1.22 mg),新生儿评分、pH、PO_(2)均高于对照组,新生窒息率、PCO_(2)低于对照组,不良反应(11.9%)低于对照组(26.8%)(均P<0.05)。结论:腰硬联合阻滞麻醉可更好地抑制重度子痫前期剖宫产患者手术应激反应,对患者血流动力学影响小,安全性好。
Objective:To analyze the effects of combined spinal-epidural anesthesia during cesarean section on stress response,hemodynamics,and maternal and infant outcomes of the pregnant women with severe preeclampsia.Methods:115 pregnant women with severe preeclampsia who all had received cesarean section from January 2017 to June 2019 were collected retrospectively.According to the different anesthesia method,these women were divided into control group(56 cases were given epidural anesthesia)and study group(59 cases were given combined spinal-epidural anesthesia).The stress response,the hemodynamic changes,the anesthesia effects,the maternal and infant outcomes,and the adverse reactions of the women during the perioperative period were compared between the two groups.Results:The values of the stress indexes of the women in both groups after surgery had increased significantly,but which of the women in the study group post operation immediately,and 24h and 48h after surgery were significant lower than those of the women in the control group(P<0.05).The values of diastolic blood pressure(SBP)and systolic blood pressure(DBP)of the women in the two groups were all significant lower than those before anesthesia,while which of the women in the study group were significant higher than those of the women in the control group(P<0.05).The heart rate(HR)of the women in the two groups when anesthesia stabilization,operation started,or fetal delivery was significant higher than that before anesthesia,but which after operation was significant lower than that before anesthesia(P<0.05).The HR of the women in the study group at birth was significant lower than that of the women in the control group,but which of the women in the study group at the end of operation was significant higher than that of the women in the control group(P<0.05).The onset time of anesthesia(2.3±1.4 min)and the time of maximum anesthesia level(8.5±3.5 min)of the women in the study group were significant lower than those(6.3±1.5 min and 16.3±3.2 min)of the women in the control group,and the dosage of ephedrine(12.31±2.10 mg)of the women in the study group was significant higher than that(7.55±1.22 mg)of the women in the control group.Neonatal score,and the PH and PO_(2) values of the women in the study group were significant higher than those of the women in the control group,but the neonatal asphyxia rate and PCO_(2) value of the women in the study group were significant lower than those of the women in the control group.The adverse reactions rate(11.9%)of the women in the study group was significant lower than that(26.8%)of the women in the control group(all P<0.05).Conclusion:Combined spinal-epidural anesthesia can better inhibit the stress response of the women during cesarean section with severe preeclampsia,which has little impact on their hemodynamics,can guarantee the maternal and infant outcomes,and has high safety.
作者
付强
周莹
胡涛
陈勇
池小薇
FU Qiang;ZHOU Ying;HU Tao;CHEN Yong;CHI Xiaowei(The Third People's Hospital of Chengdu, Sichuan Province, 610031)
出处
《中国计划生育学杂志》
2021年第10期2181-2184,2188,共5页
Chinese Journal of Family Planning
关键词
重度子痫前期
剖宫产术
腰硬联合阻滞麻醉
应激反应
血流动力学
母婴结局
Severe preeclampsia
Cesarean section
Combined spinal-epidural anesthesia
Stress response
Hemodynamics
Maternal and infant outcomes
