摘要
目的比较临床常用的不同椎管内麻醉方式和局部麻醉药物用于择期剖宫产手术的麻醉效果和满意度,并观察其对剖宫产手术快速康复的影响。方法本研究为一项前瞻性研究,采用随机、对照、双盲的研究方法。选取2022年4月至10月于广州医科大学附属第三医院行剖宫产手术的150例产妇,美国麻醉医师协会(ASA)Ⅰ~Ⅱ级,年龄范围22~39岁,单胎足月孕产妇,无全身其他系统合并症,子宫下段横切口术式。采用随机数字表法分为腰硬联合麻醉罗哌卡因组(SR组)、硬膜外麻醉利多卡因组(EL组)和硬膜外麻醉甲哌卡因组(EM组),每组50例。SR组采用直入法经L3~4间隙行腰硬联合穿刺,在蛛网膜下腔应用等比重的0.5%罗哌卡因3 ml,EL组和EM组采用直入法经L2~3间隙行硬膜外穿刺,分别在硬膜外腔应用2%利多卡因和2%甲哌卡因,各12~15ml。3组硬膜外腔均留置硬膜外导管。观察3组产妇的麻醉效果(药物起效时间、药物剂量、药物达到的最高平面、新生儿血气结果)、麻醉满意度(产妇、外科医生和麻醉医生对麻醉效果的满意度),记录3组产妇的不良反应与快速康复相关的恢复指标(运动阻滞恢复和Bromage评分、术后镇痛的情况、首次下床活动、排气排尿以及出院的时间)情况。采用One way ANOVA、Kruskal-Wallis秩和检验进行统计分析。结果与SR组相比,EL和EM两组麻醉起效时间延长,药物用量增加。SR组低血压、恶心呕吐和术后尿潴留的发生率分别为34%(17/50)、24%(12/50)、14%(7/50),与EL组[14%(7/50)、4%(2/50)、2%(1/50)]和EM组[16%(8/50)、6%(3/50)、0]相比,差异均有统计学意义(均P<0.05)。SR、EL和EM组产妇的首次下床时间分别为(23.52±4.22)h、(18.30±3.80)h、(19.10±5.93)h,出院时间分别为(72.68±12.69)h、(65.28±19.88)h、(65.67±6.14)h,这说明在术后恢复指标上,EL、EM两组与SR组相比,具有一定的优势(均P<0.05)。3组麻醉满意度、新生儿血气结果、术后镇痛效果等比较,差异均无统计学意义(均P>0.05)。此外,EL和EM两组在麻醉效果和术后恢复指标中的差异均无统计学意义(均P>0.05)。结论与腰硬联合麻醉应用罗哌卡因相比,硬膜外麻醉采用利多卡因或甲哌卡因能够在不同程度上提高患者术后快速康复的效果,表现出现代加速康复理念的优越性。
Objective To compare the anesthesia effects and satisfaction of different intraspinal anesthesia methods and local anesthesia drugs for women taking selective cesarean section,and to observe their impact on the women's rapid recovery.Methods This was a prospective,randomized,controlled,and double-blind study.A total of 150 single pregnant women who underwent selective cesarean section in The Third Affiliated Hospital of Guangzhou Medical University from April to October 2022 were selected;their America Association of Anesthesiologists(ASA)grade wasⅠ-Ⅱ;they were 22-39 years old;they had no complications of other systemic systems;they took subuterine transectomy.They were divided into a ropivacaine group(SR group),an epidural lidocaine group(EL group),and an epidural mepivacaine group(EM group)by the random number table method,with 50 cases in each group.In the SR group,3 ml of isobaric 0.5%ropivacaine was directly applied in the subarachnoid space into the L3-4 interspace;in the EL and EM groups,12-15 ml of 2%lidocaine or 2%mepivacaine were applied in the epidural space through L2-3 direct approach,respectively.The indwelling catheters were placed in the epidural spaces of all the three groups.The anesthesia effects(time to most superior level of block obtained,drug dose,maximal cephalad sensory block level,and neonatal blood gas),anesthesia satisfaction(satisfaction of patients,surgeons,and anesthesiologists with anesthesia effects),complications,and related recovery indicators(motor block recoovery,Bromage score,postoperative analgesia,time for first off-bed activity,time for first exhausting,time for first peeing,and hospital stay)were observed and recorded.One way ANOVA and Kruskal-Wallis rank sum test were applied.Results The EL and EM groups had longer duration of anesthetic drug effect and increased drug dosage.However,the incidences of intraoperative hypotension and nausea and vomiting and postoperative urine retention were 34%(17/50),24%(12/50),and 14%(7/50)in the SR group,were 14%(7/50),4%(2/50),and 2%(1/50)in the EL group,and were 16%(8/50),6%(3/50),and 0 in the EM group,with statistical differences(all P<0.05).The times for first off-bed activity of the ER,EL,and EM groups were(23.52±4.22)h,(18.30±3.80)h,and(19.10±5.93)h,respectively;the the hospital stays were(72.68±12.69)h,(65.28±19.88)h,and(65.67±6.14)h respectively;it indicated that the EL and EM groups had better postoperative recovery indicators(all P<0.05).There were no statistical differences in satisfaction,neonatal blood gas,and administration of narcotics in the postoperative period between the three groups(all P>0.05).Moreover,there were no statistical differences in the anesthesia effect and postoperative recovery indicators between the EL and EM groups(all P>0.05).Conclusion Compared to ropivacaine combined with lumbar epidural anesthesia,epidural application of lidocaine or mepivacaine can promote the patients'rapid postoperative recovery,and it is consistent with the modern ERAS concept.
作者
王牧野
李煜杰
王寿平
Wang Muye;Li Yujie;Wang Shouping(Department of Anesthesiology,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510145,China)
出处
《国际医药卫生导报》
2023年第14期1980-1985,共6页
International Medicine and Health Guidance News
基金
广东省基础与应用基础面上项目(2021A1515220002)
广州市科技局市校联合项目(2022-1020389)
广州市荔湾区重点卫生科研项目(202201011)。
关键词
剖宫产术
麻醉方式
局麻药物
快速康复
Cesarean section
Anesthesia method
Local anesthetic
Rapid recovery
