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腰硬联合麻醉应用于先心合并轻中度肺高压产妇剖宫产术的可行性分析
Efficacy of combined spinal-epidural anesthesia in caesarean section patients with congenital heart disease and mild to moderate pulmonary hypertension.
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DOI:
作者:
忻纪华
Xin Jihua
作者单位:
上海交大医学院附属仁济医院麻醉科(南院)
Department of Anesthesia,Shanghai Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 201112,China
关键词:
先天性心脏病;腰硬联合麻醉 ;肺动脉高压; 剖宫产术
Congenital heart disease, Combined spinal-epidural anesthesia, pulmonary artery hypertension ,cesarean section
摘要:
目的 评价低剂量腰硬联合麻醉在先心合并轻中度肺高压产妇剖宫产术中应用的可行性。方法 36例先心合并轻中度肺高压择期行剖宫产术的产妇,随机分为3组:连续硬膜外麻醉组(E组)、5mg罗哌卡因腰麻+连硬麻醉组(S5组)和7.5mg罗哌卡因腰麻+连硬麻醉组(S7.5)组(n=12)。麻醉:以腰2-3间隙为穿刺点行椎管内麻醉。E组产妇实行连续硬膜外麻醉,2%利多卡因试验剂量后,追加0.75%罗哌卡因控制麻醉平面T6~T8。S5组和S7.5组产妇实行腰硬联合麻醉,分别给予罗哌卡因5mg和7.5mg蛛网膜下腔阻滞后,留置硬膜外导管,根据麻醉平面追加0.75%罗哌卡因控制麻醉平面T6~T8。记录母体入室,椎管内末次给药后(5min、7.5min、10min、15min),手术开始,胎儿娩出即刻,娩出后5min、30min和手术结束时的心率(HR)和桡动脉平均压(MAP)。记录产妇术中牵拉反应的发生。胎儿娩出时母体动脉和脐动、静脉血气结果。结果 S5组与E组同样可以为先心合并轻中度肺高压产妇剖宫产术中提供稳定的血流动力学变化,但S5组麻醉效果优于E组。而S7.5组与前2组相比,术中MAP明显下降。E组术中牵拉反应发生率明显高于S5组和S7.5组。三组的脐动、静脉血气结果无明显差异,新生儿1min和5min的Apgar’s评分均为10分。结论 低剂量腰麻(0.5%罗哌卡因5mg)合并硬膜外麻醉可安全用于先心合并轻中度肺高压产妇的剖宫产术。
Objective To evaluate the efficacy of low-dose combined spinal-epidural anesthesia(CSEA) in caesarean section patients with congenital heart disease(CHD) and mild to moderate pulmonary hypertension(PH). Methods Thirty-six patients presented for elective caesarean section with CHD and mild to moderate PH were randomly allocated to one of the 3 groups:E Group (receieved continuous epidural anaesthesia), S5 Group (receieved intrathecal 5mg ropivacaine with CSEA )and S7.5 Group (receieved intrathecal 7.5mg ropivacaine with CSEA). The epidural space was located at L2-3 interspace. Patients in E Group receive 0.75% ropivacaine after first dose of 2% lidocaine under epidural anesthesia to control the sensory blocking to T6-8 plane. Patients in S5 Group and S7.5 Group received intrathecal 5mg and 7.5mg ropivacaine separately, following which an epidural catheter was inserted into epidural space, then Patients received 0.75% ropivacaine to control the sensory blocking to T6-8 plane. Patients’ heart rate(HR) and mean radial artery pressure(MAP) were measured at each time point (before anesthesia, 5min、 7.5min、10min and 15min after induction of anesthesia, beginning of operation, immediately after delivery, 30min after delivery,and the end of operation). The incidence of referred pain was recorded during the operation. We also recorded the artery blood gas of maternal、artery and venous blood gas of fetal. Results S5 group was similar in hemodynamics to E group for the patients with CHD and mild to moderate PH. But the efficary of S5 group was better than E group. MAP in S7.5 Group was significantly decrease as compared with other two groups. The incidence rate of referred pain in E Group was higher than S5 Group and S7.5 Group. There was no significantly difference of blood gas in maternal nor in fetal. The Apgar’s score at 1min and 5min were all 10. Conclustion Low-dose CSEA(0.5% ropivacaine 5mg) can be safely used in caesarean section for the patients with CHD and mild to moderate PH.
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