妊娠高血压综合征剖宫产麻醉选择.docVIP

妊娠高血压综合征剖宫产麻醉选择 　 作者：熊国强，黄仁健，覃军，杨军良 【摘要】 目的：对比观察连续硬膜外麻醉（CEA）和蛛网膜下腔硬膜外麻醉（CSEA）用于妊娠高血压综合征(简称妊高征)剖宫产手术临床麻醉效果和对新生儿的影响。方法：选择妊高征拟行剖宫产术的孕妇186例，随机分为CSA组或CSEA组。观察两组感觉及运动阻滞效果，生命体征变化，恶心、呕吐等不良反应发生情况。结果:两组麻醉效果（镇痛、肌松）无显著性差异（Pgt;0.05），均能满足手术需要；两组麻黄碱使用总量无显著性差异（Pgt;0.05），两组均未出现一过性神经症状（TNS）及头痛、头晕等神经系统并发症。麻醉后2，7 min血压下降发生率组间有显著性差异（Plt;0.05），恶心、呕吐发生率组间有显著性差异（Plt;0.05），麻醉起效时间、完善时间、最高平面有显著性差异（Plt;0.05）。SpO2从麻醉开始到胎儿娩出后（15 min内）无显著性差异（Pgt;0.05）。结论：CSA 用于妊高征剖宫产手术比较安全；CSEA麻醉效果好，经过综合处理在妊高征剖宫产术中可以选择。 【关键词】 高血压/妊娠期；麻醉，硬膜外；并发症；剖宫产术 ［ABSTRACT］ Objective: To observe the effects of continuous epidural anesthesia (CEA) and combined subarachnoid epidural anesthesia(CSEA) for cesarean performed on patients with pregnancyinduced hypertension and their effects on the neonate. Methods: 186 patients with pregnancyinduced hypertension who underwent cesarean were randomly divided into CEA group and CSEA group. The sensory and motor block effects, vital signs and adverse reaction such as nausea and vomiting were recorded. Results: Without any temporary neurological symptoms or neurological complication like headache, dizziness, both CEA and CSEA can meet the requirement of cesarean. The anesthesia effects, total dose of Ephedra and the SpO2 range calculated from anesthesia applying to 15 min after delivery are not significant different between the two groups (Pgt;0.05), while the blood pressure decrease rate 2min or 7 min after applying anesthesia, incidence of vomiting and nausea, initial effect time, complete effective time and the highest level of anesthesia are significant different (Plt;0.05). Conclusion: For cesarean performed on patients with pregnancyinduced hypertension, CEA is safer while CSEA is more effective. If combined with comprehensive measures to prevent complications, CSEA is applicable in patients with pregnancyinduced hypertension. ［KEY WORDS］ Pregnacyinduced hypertension; Continuous epidural anesthesia; Combined subarachnoid epidural anesthesia; Anesthesia complicat