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腰硬联合麻醉在剖宫产麻醉中的应用效果观察

The application value of combined spinal-epidural anesthesia in cesarean section

摘要:

目的 探讨腰硬联合麻醉在剖宫产术中的应用效果及并发症发生情况.方法 将82例拟行剖宫产的孕妇采用随机数字表法分为观察组与对照组,每组41例.观察组行腰硬联合麻醉;对照组行硬膜外麻醉.评价两组麻醉效果、围术期血流动力学变化及术后并发症发生率.结果 观察组麻醉优良率100.00%,明显高于对照组的87.80%(χ2=5.325,P<0.05);观察组感觉阻滞平面固定(T1)、手术开始(T2)、胎儿娩出(T3)、手术结束(T4)时平均动脉压(MAP)均明显低于对照组(t=3.893、3.934、3.991、2.231,均P<0.05);观察组麻醉起效时间、麻醉持续时间、Bromage评分均显著优于对照组(t=14.425、15.791、4.655,均P<0.05);观察组仰卧位综合征发生率26.83%,明显高于对照组的4.88%(χ2=7.405,P<0.05).结论 相比硬膜外麻醉,剖宫术中腰硬联合麻醉起效快、麻醉维持时间长,麻醉效果明确,但在血流动力学方面相对不稳定,仰卧位综合征发生率明显高.

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abstracts:

Objective To explore the application effect and complications of combined spinal -epidural anesthesia in cesarean section .Methods 84 pregnant women who planed to undergo cesarean section were divided into the observation group and the control group by the random number table method ,41 cases in each group .The observation group was given combined spinal -epidural anesthesia ,while the control group was given epidural anes-thesia.The anesthetic effects , perioperative hemodynamic changes and the incidence of postoperative complications were evaluated .Results The excellent and good rate of anesthesia in the observation group was significantly higher than that in the control group(100.00%vs.87.80%)(χ2 =5.325,P<0.05).The mean arterial pressure(MAP) of the observation group when the plane of sensory block was fixed ( T1 ) , at the beginning of operation ( T2 ) , at fetal delivery(T3) and at the end of operation(T4) were significantly lower than those of the control group (t=3.893, 3.934,3.991,2.231,all P<0.05).The onset time of anesthesia,duration of anesthesia and Bromage score of the observation group were significantly better than those of the control group (t=14.425,15.791,4.655,all P<0.05). The incidence rate of supine syndrome in the observation group was significantly higher than that in the control group (26.83%vs.4.88%)(χ2 =7.405,P<0.05).Conclusion Compared with epidural anesthesia ,combined spinal-epidural anesthesia has characteristics of fast onset and long duration ,and the anesthetic effect is clear .However ,it is relatively unstable in terms of hemodynamics ,and the incidence of supine syndrome is significantly higher .

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作者: 陈良巧 [1] 郭琛 [1]
期刊: 《中国基层医药》2018年25卷8期 957-960页 ISTIC
栏目名称: 论著
DOI: 10.3760/cma.j.issn.1008-6706.2018.08.002
发布时间: 2018-04-27
基金项目:
浙江省卫生厅立项科研项目(Y14H062530)Department of Anesthesiology,Wenling Hospital of Traditional Chinese Medicine,Wenling,Zhejiang 317500,China Department of Anesthesiology,Wenling Hospital of Traditional Chinese Medicine,Wenling,Zhejiang 317500,China Research Project of Zhejiang Provincial Health Department
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