三种麻醉方式用于剖宫产手术比较.docVIP

三种麻醉方式用于剖宫产手术比较 　【摘要】 目的 比较单次硬膜外麻醉、腰-硬联合麻醉、连续硬膜外麻醉在剖宫产手术中的效果。方法 急诊手术240例，随机分为三组，Ⅰ组为单次硬膜外麻醉，Ⅱ组为腰-硬联合麻醉,Ⅲ组为连续硬膜外麻醉。术中观察平均动脉压、心率、血氧饱和度，记录麻醉效果和起效时间、局麻药用量及术中、术后并发症。结果 三组患者在平均动脉压、心率、血氧饱和度差异无统计学意义（P＞0.05），Ⅰ组患者麻醉效果最好，满意率100%，Ⅱ组次之，Ⅲ组最差；起效时间，Ⅱ组最快，Ⅰ组次之，Ⅲ组最慢，Ⅲ组与Ⅰ、Ⅱ组间有显著性差异。局麻药用量Ⅱ组最少。术中、术后并发症Ⅰ组有低血压4例，Ⅱ组有低血压12例，恶心呕吐4例，术后头痛9例，Ⅲ组低血压5例，恶心呕吐1例。三组患者均无全脊髓麻发生。结论 单次硬膜外麻醉用于剖宫产手术是最好的方法。 【关键词】 单次硬膜外麻醉；腰-硬联合麻醉；连续硬膜外麻醉；剖宫产 ［Abstract］ Objective To compare the single epidural anesthesia,combined spinal-epidural anesthesia,the continuous epidural anesthesia for cesarean section.Methods 240 cases with emergency operation were randomly divided into three groups.Group Ⅰ was single epidural（n=80）,group Ⅱ was combined spinal-epidural anesthesia （n=80）,group Ⅲ was the continuous epidural anesthesia（n=80）.Interoperation mean arterial pressure（MAP）,heart rate（HR）,pulseoxygensaturation（SpO2） were observed,the anesthesia effect,start effect time,local anesthesia dosage,introoperation,postoperation complications were record.Results The MAP,HR,SpO2 were no significant difference in the three groups.Group Ⅰ patients were the best in the anesthesia effect,the satisfaction rate was 100%,the seconds was group Ⅱ,the most slow was group Ⅲ.Group Ⅲ and group Ⅰ,Ⅱ had significant difference.The local anesthesia dosage in group Ⅱ was the minimal,the complication in group Ⅰ had the low blood pressure for 4 cases,group Ⅱ had 12 cases,nausea and vomiting had 4 cases,headache had 9 cases,group Ⅲ had the low blood pressure for 5 cases,nausea and vomition had 1 case,whole spinal anesthesia did not occur in three groups.Conclusion Single epidural anesthesia is the best method for cesarean section. ［Key words］ single epidural anesthesia； combined spinal-epidural anesthesia；continuous epidural anesthesia;cesarean section 笔者针对单次硬膜外麻醉用于剖宫产手术的效果探讨如下。 1 资料与方法 1.1 一般资料 选择2007年7月～2008年1月的急诊行剖宫产手术的患者240例。年龄20～38岁，体重54～102 kg,平均78 kg。无严重心、肺、肝肾功能异常疾患。ASA分级Ⅰ～Ⅱ级。随机分为三组，Ⅰ组为单次硬膜外组，Ⅱ组为腰-硬联合麻醉组，Ⅲ组为连续硬膜外组。所有患者入室后均常规面罩吸氧，流量为3 L/min，连接监测仪