摘要
目的研究预负荷输液联合小剂量腰硬联合麻醉是否可降低剖宫产手术中产妇心血管系统并发症的发生率。方法剖宫产手术病人随机分为4组，每组30人：晶体液预负荷＋腰麻组（CR—SA），胶体液预负荷＋腰麻组（CO—SA），晶体液预负荷＋小剂量腰硬联合麻醉组（CR—CSEA），胶体液预负荷＋小剂量腰硬联合麻醉组（CO—CSEA）；预负荷输注乳酸钠林格氏液或琥珀酰明胶注射液500ml；腰麻为：0．5％布比卡因7．5mg＋芬太尼15μg，小剂量腰硬联合麻醉为：0．5％布比卡因5mg＋芬太尼15μg腰麻，5min后硬膜外给予0．25％布比卡因10ml；比较各组术中发生低血压、心律失常、恶心、呕吐、寒战的发生率以及麻黄素的用药量差异；比较各组麻醉感觉最高阻滞平面、Bromage评分、腹肌松弛优等率以及新生儿出生后1min、5min的Apgar评分和出生即刻的脐动脉血气分析值的差异。结果CO—CSEA组产妇术中低血压发生率为16．7％，显著低于CR．SA组（46．7％），CO—CSEA组与CO-SA组（20．0％）和CR—CSEA组（26．7％）相比，低血压发生率有降低趋势，但无统计学意义；CO—CSEA组产妇术中心律失常发生率为3．3％，显著低于CR—SA组（33．3％）和CO—SA组（23．3％），但与CR—CSEA组（10．0％）比较无统计学意义；CO-CSEA组与CR-SA组相比，产妇术中麻黄素用药量显著减少；CO—CSEA组和CO—SA组恶心、呕吐的发生率显著低于CR—SA组；各组寒战反应发生率都较低，无统计学差异；各组病人麻醉感觉阻滞平面、Bromage评分、腹肌松弛优等率均无统计学差异，新生儿Apgar评分和脐动脉血气分析值也均在正常范围，无统计学差异。结论预负荷输注胶体液与小剂量腰硬联合麻醉方法联合应用，可有效增强产妇术中心血管系统的稳定性，降低低血压和心律失常的发生率，并可减少术中恶心、呕吐等
Objective To investigate whether combination of preload infusion and low-dose spinal-epidural anesthesia may reduce the incidence of cardiovascular complications for parturients undergoing caesarean section. Methods Parturients undergoing elective cesarean section were randomly allocated to one of four groups （ n = 30） to receive crystalloid preload infusion followed with spinal block （ Group CR-SA） , colloid preload infusion with spinal anesthesia （ Group CO-SA） , crystalloid preload followed with combining low-dose spinal - epidural block （ Group CR-CSEA ）, or colloid preload infusion with combining low-dose spinal-epidural anesthesia （ Group CO-CSEA）. Bupivacaine 7.5 mg and fentanyl 15 μg was injected into subarachnoid space for spinal anesthesia, and bupivacaine 5 mg ＋ fentanyl 15 μg was injected into subarachnoid space followed with epidural injection of 0.25% bupivacaine 10ml for spinal - epidural block. The changes of SBP and HR, and the occurrence of adverse effects were observed. The block effects and the safety of neonate were assessed. Results The incidence of maternal hypotension was 16.7% in Group CO-CSEA that was significantly lower than in Group CR-SA （46.7%）. Compared with Group CO-SA （20.0%） and Group CR-CSEA （26.7%） , the incidence of hypotension in Group CO-CSEA tended decreasing, but no statistical difference. The occurrence of arrhythmia in Group CO-CSEA （3. 3% ） was significantly lower than in Groups CR-SA （33.3%） and CO-SA （23.3%）, but no significant difference compared with CR- CSEA （ 10.0% ）. Ephedrine administration was needed significantly less for Group CO-CSEA patients than that for CR-SA ones. The incidence of nausea and vomiting was significantly lower in Groups CO-CSEA and CO-SA than in Group CR-SA. The frequency of shivering was low in four Groups and there was no significant difference between them. No differences in block effect, fluid infusion volume and neonatal outcome were found among the four groups. Conclusion Colloid pre
出处
《国际麻醉学与复苏杂志》
CAS
2008年第4期293-297,共5页
International Journal of Anesthesiology and Resuscitation
基金
东莞市科委基金资助项目（项目编号：2008105150047）
关键词
腰麻
腰-硬膜外联合麻醉
预负荷
晶体液
胶体液
心血管系统
剖宫产
spinal anesthesia
combined spinal-epidural anesthesia
preload
crystalloid
colloid
cardiovascular system
cesarean section
