腰麻-硬膜外联合阻滞应用于急诊剖宫产手术临床观察.docVIP

腰麻-硬膜外联合阻滞应用于急诊剖宫产手术临床观察 　 作者：许华强　郑少霞　李莉　许顺发 【关键词】 腰麻 　　摘要：目的：探讨腰麻-硬膜外联合阻滞（CSEA）用于急诊剖宫产手术的应用效果。方法：选择ASAⅠ～Ⅱ级急诊行剖宫产的产妇100例，随机分成腰-硬联合麻组和单纯硬膜外（EA）组各50例，对两组产妇的麻醉起效时间、麻醉至胎儿娩出时间（IDI）、手术时间、麻醉效果、局麻药用量、麻醉前后血流动力学变化、新生儿评分及不良反应进行比较分析。结果：CSEA组麻醉起效时间、IDI、手术时间均短于EA组（Plt;0.05），麻醉效果明显优于EA组（Plt;0.05），局麻药用量显著减少（Plt;0.01），但低血压发生率较EA组大（Plt;0.05）,其他不良反应未见统计学差异。结论：CESA比EA麻醉起效更快、效果更确切，是急诊剖宫产更为可取的麻醉选择。 　　关键词：腰麻-硬膜外联合阻滞；硬膜外阻滞；剖宫产 　　Clinical Study of Combined Spinal-epidural Anesthesia for Emergency Cesarean Section 　　Abstract： Objective： To study the clinical efficiency of combined spinal-epidural anesthesia (CSEA) in patients undergoing emergency cesarean section. Methods： 100 ASA Ⅰ～Ⅱ patients undergoing emergency cesarean section were randomly divided into two groups : CSEA group(50 cases) and continuous epidural anesthesia (EA) group(50 cases).The anesthesia inducement time,the incison to delivery interval (IDI),the operative duration,the quality of anesthesia,the dosage of anesthesia agents,the change of vital signs, the side effects and neonatal state(Apgar)were observed. Results： The operative duration ,IDI and the anesthesia inducement in CSEA group were much shorter than that of EA group(Plt;0.05). The effect of anesthesia in CSEA group was much better than that of EA group(Plt;0.05), and much less local anesthesia agents was used(Plt;0.01).Although the possibility of hypotension was higher in CSEA group, there were not obvious differences between two groups in neonatal Apgar score and other side effects. Conclusion： CESA has faster inducement and greater efficiency with a good foreground for clinical application in emergency cesarean section. 　　Key words：Combined spinal-epidural anesthesia；Epidural anesthesia；Cesarean section 　　急诊剖宫产多数是由于各种因素所致胎儿宫内窘迫而施行，其要求麻醉诱导迅速，效果确切，肌肉松弛，对母婴安全。腰麻―硬膜外联合阻滞（CSEA）和硬膜外阻滞（EA）都是急诊剖宫产常用的麻醉方法。本研究将CSEA与EA下行急诊剖宫产的临床效果进行比较，报告如下： 　　1 资料与方法 　　1.1 一般资料：急诊行剖宫产的产妇100例，ASAⅠ～Ⅱ级，年龄20～34岁，体重50～81Kg，身高150～168cm，随机分成CSEA和EA两组，每组50例。两组产妇年龄、身高、体重无明显差异。 　　1.2 麻醉方法：两组产妇均无