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腰-硬联合麻醉用于子痫前期患者的安全性研究
The research of the safety of combined spinal-epidural anesthesia in patients with preeclampsia undergoing cesarean section

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DOI:
作者:
陈秀斌，刘志强
Xiubin Chen
作者单位:
上海市第一妇婴保健院
Shanghai First Maternity and Infant Hospital
关键词:
麻醉；腰硬联合；子痫前期
anesthesia; CSEA; preeclampsia
摘要:
[摘要] 目的 观察腰-硬联合麻醉用于子痫前期患者的可行性及安全性。方法 2010年9月至2011年5月，选取20例需行择期剖宫产的子痫前期患者作为观察组，采用腰硬联合麻醉（CSEA）；选取20例需行择期剖宫产的子痫前期患者作为对照组1，采用连续硬膜外麻醉（CEA）；选取20例需行择期剖宫产的健康孕妇作为对照组2，采用腰硬联合麻醉。观察麻醉前、麻醉后5分钟、麻醉后10分钟、胎儿娩出后即刻的收缩压(SBP)、舒张压(DBP)和心率(HR)，麻醉开始至感觉阻滞平面达T8的时间（t），术中补液量，术中低血压发生的例数，术后头痛发生率等。结果 与对照组1相比麻醉前基础SBP、DBP及HR的差异无显著性（P>0.05），麻醉后5分钟、10分钟及胎儿娩出后即刻两组收缩压、舒张压的下降值及心率变化的差异无显著性（P>0.05）。麻醉开始至感觉阻滞平面达T8的时间观察组明显短于对照组1（P<0.01）。术中补液量两组差异无显著性（P>0.05）。术中低血压发生例数两组差异无显著性（P>0.05）。与对照组2相比观察组麻醉前基础SBP、DBP明显高于对照组2（P<0.01），两组麻醉前基础HR的差异无显著性，麻醉后5分钟、10分钟舒张压的下降值明显大于对照组2（P<0.01），胎儿娩出后即刻观察组收缩压、舒张压的下降值明显大于对照组2（P<0.01），但两组心率变化的差异无显著性（P>0.05）。麻醉开始至感觉阻滞平面达T8的时间两组差异无显著性（P>0.05）。术中补液量观察组明显少于对照组2（P<0.01）。术中低血压发生例数两组差异无显著性（P>0.05）。60例患者无一例发生头痛。结论 子痫前期患者采用腰硬联合麻醉与硬膜外麻醉的血流动力学变化是相似的，子痫前期患者CSEA麻醉后血压下降值明显大于健康孕妇组，但真正发生低血压的例数两者差异并无显著性。腰硬联合麻醉具有起效快、阻滞完善、用药量小、并发症少、麻醉阻滞时间能够根据手术需要延长等优点，用于子痫前期患者是安全有效的。
[Abstract] objective To observe the feasibility and safety of combined spinal-epidural anesthesia in patients with preeclampsia undergoing cesarean section. Methods From September 2010 to May 2011,40 patients with preeclampsia who would take selected cesarean section were divided into two groups,20 as the observe group under combined spinal-epidural anesthesia(CSEA), the others as the contrast group1 under continuous epidural anesthesia(CEA).20 healthy parturients were selected as contrast group2 under CSEA in the same period. The heart rate (HR), systolic blood pressure(SBP), diastolic blood pressure(DBP) were recorded before and after anesthesia, the time(t) from the induction of anesthesia to sensory block to T8 plane, the volume of fluids administered; the incidence of hypotension and post-operative headache were also recorded. Result Compared with the contrast group1，there is no significant difference in baseline SBP、DBP and HR, there is no significant difference in the magnitude of the decrease in SBP, DBP and HR after anesthesia. The observe group’s time(t) from the induction of anesthesia to sensory block to T8 plane is significantly shorter than contrast group1. The volume of fluids administered; the incidence of hypotension and post-operative headache is of no significant difference between the two groups. Compared with the contrast group2，the baseline SBP and DBP are significantly higher than group2, the magnitude of the decrease in DBP after anesthesia is significantly larger than group2,but there is no significant difference in HR before and after anesthesia. The volume of fluids administered by observe group is significantly less than that in contrast group2. The incidence of hypotension and post-operative headache is of no significant difference between the two groups. Conclusion The hemodynamic is similar in preeclampsia patient undergoing CSEA or CEA for cesarean section. For preeclampsia patient the magnitude of the decrease in DBP after CSEA is significantly larger than the healthy parturient, but there is no significant difference in the incidence of hypotension. CSEA had epidural block and subarachnoid block advantages, including rapidity, sufficient block, reliability of the subarachnoid block with the flexibility of continuous epidural block to extend duration of analgesia. CSEA is suitable and safe for patients with preeclampsia requiring cesarean section.

 

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