腰-硬联合麻醉在剖宫产手术应用.docVIP

腰-硬联合麻醉在剖宫产手术应用【摘要】 目的 观察腰麻-硬膜外联合麻醉在剖宫产手术中的麻醉效果和相关不良反应。方法 随机将60例剖宫产手术的足月单胎产妇随机均分为两组：E组，实施硬膜外麻醉（EA）；S组，实施腰麻-硬膜外联合麻醉（CSEA)，给予患者布比卡因9～11 mg。监测血流动力学变化，评估麻醉效应和恶心呕吐等不良反应发生情况。结果 两组血压与心率比较无统计学意义，与E组相比较,S组镇痛效果更佳，差异有统计学意义（P0.05)。结论 2种麻醉方法均可以满足临床需要，但CSEA镇痛效果优于EA, 提供更好的导尿舒适度，且不良反应少。 【关键词】硬膜外麻醉；腰-硬联合麻醉；布比卡因；剖宫产术?? Application of combined spinal epidural anesthesiain cesarean deliver WANG Hong-lei， ZHU Ai-bing. Department of Anesthesiology, Xi Bei People’s Hospital,Wu Xi. Wuxi 212001,China ? 【Abstract】 Objective To evaluate the anaesthesia effect and side-effect of combined spinal epidural anesthesiain cesarean section.Methods 60 full-tern gravitas undergoing cesarean deliver were divided into two groups with 30 cases each,group E receivedepidural anesthesia.Group S received combined spinal epidural anesthesia with bupivacaine 9～11 mg .The hemodynamic were monitored.The anaesthesia efect were evaluate. The adverse reaction (nausea and vomiting ,pruritus,respirtory depression)were recorded . Results There was no significant differnce in two groups for BP and HR .Compared with thegroup E, There were more excellent analgesic effecin group S (P0.05). Conclusion Troughtwoanaesthesia wayswere useful，CSEA was more effective thanEA in providing analgesia and suppressing the uncomfortable responses of retaining urethral catheterization to cesarean delivery surgery .? 【Key words】Epidural anesthesia；Combined spinal epidural anesthesia；Bupivacaine ；Cesarean section 腰麻-硬膜外联合麻醉（CSEA）是一种新型麻醉方法，具有腰麻（SA）和硬膜外麻醉（EA）双重优点，近年来已广泛应用于临床。本研究旨在比较CSEA和EA在新式剖宫产中应用的麻醉效果和不良反应，现报告如下。? 1 资料与方法? 1.1 一般资料 选择80例ASAⅠ～Ⅱ级，年龄22～35岁，体质量50～82 kg，身高150～172 cm产妇。均为初产单胎，无妊娠并发症。孕足月需行剖宫产术。随机均分为硬膜外麻醉组（EA组)和腰-硬联合麻醉（CSEA组)。? 1.2 麻醉方法 两组术前30 min均肌内注射苯巴比妥钠100 mg和阿托品0.5 mg。入室后常规面罩吸氧，监测BP、HR、SPO2、ECG。入室后快速滴入乳酸钠林格注射液300～500 ml。CSEA组采用AS-E/S型腰麻-硬膜外联合穿刺针25G/16G，经L2～3椎间隙行硬膜外穿刺，刺破蛛网膜后于蛛网膜下隙注入0.5%布比卡因等比重液（2 ml 0.75%布比卡因+脑脊液1 ml稀释）1.8～2.2 ml(9～11 mg)，注射速度控制在15～20 s；同时经硬膜外腔向头端置管3～4 cm备用，仰卧位后调节手术床使痛觉阻滞平面达T7。若术中