摘要
目的观察蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉(CSEA)用于子痫前期患者的可行性及安全性。方法各选取20例于2010年9月-2011年5月间行择期剖宫产术的子痫前期患者作为子痫CSEA组和子痫连续硬膜外腔阻滞麻醉(CEA)组,另选20例行择期剖宫产术的健康孕妇作为健康CSEA组。记录麻醉前收缩压(SBP)、舒张压(DBP)及心率(HR)的基础值,麻醉后即刻、麻醉后5 min、麻醉后10 min和胎儿娩出后即刻各时间点的SBP、DBP及HR的下降值,麻醉开始至神经阻滞平面达第8胸椎的时间,术中补液量,术中低血压及术后头痛的发生情况等。结果子痫CSEA组、子痫CEA组和健康CSEA组的年龄及体质指数的差异均无统计学意义(P值均>0.05)。子痫CSEA组麻醉前的SBP、DBP及HR的基础值与子痫CEA组的差异均无统计学意义(P值均>0.05)。子痫CSEA组麻醉即刻、麻醉后5 min、麻醉后10 min和胎儿娩出后即刻各时间点的SBP、DBP及HR的下降值与子痫CEA组的差异均无统计学意义(P值均>0.05)。子痫CSEA组麻醉开始至神经阻滞平面达第8胸椎的时间为(4.3±0.8)min,显著短于子痫CEA组的(16.6±2.2)min(P<0.01)。子痫CSEA组的补液量与子痫CEA组的差异无统计学意义(P>0.05)。子痫CSEA组发生低血压2例,子痫CEA组为4例,两组间的差异无统计学意义(P>0.05)。子痫CSEA组麻醉前的SBP和DBP的基础值均显著高于健康CSEA组(P值均<0.01),但两组间HR基础值的差异无统计学意义(P>0.05)。子痫CSEA组麻醉后即刻的SBP、DBP及HR的下降值与健康CSEA组的差异均无统计学意义(P值均>0.05);子痫CSEA组麻醉后5和10 min时间点的DBP的下降值均显著大于健康CSEA组(P值均<0.01),而两组间麻醉后5和10 min时间点的SBP的下降值的差异无统计学意义(P值均>0.05);子痫CSEA组胎儿娩出后即刻的SBP和DBP的下降值均显著大于健康CSEA组(P值均<0.01),但两组胎儿娩出后即刻的HR的下降值的差异无统计学意义(P>0.0
Objective To evaluate the feasibility and safety of combined spinal epidural anesthesia （CSEA） in patients with preeclampsia undergoing cesarean section. Methods From September 2010 to May 2011, 40 preeclampic patients underwent elective cesarean section under CSEA （n =20） and continuous epidural anesthesia （CEA, n = 20）, respectively. Another 20 healthy parturients received CSEA and were enrolled into the healthy-OSEA group in the same period. The systolic blood pressure （SBP）, diastolic blood pressure （DBP） and heart rate （HR） were measured at each time point （before anesthesia, immediately after anesthesia, 5 mins after anesthesia, 10 rains after anesthesia,and immediately after delivery）. The duration from induction of anesthesia to sensory block to T8 plane, intraoperative fluid infusion, and the incidence of intraoperative hypotension and postoperative headache were recorded. Results There were no significant differences in age and body mass index （BMI） among the three groups （P〉0.05）. There were no significant differences in baseline SBP, DBP and HR between preeclampsia-CSEA group and preeclampsia-OEA group （P〉0.05）. Neither were the decreased values of HR, SBP and DBP at each time point between the two groups （P〉0.05）. The duration from anesthesia induction to sensory block to T8 in the preeclampsia-OSEA group was significantly shorter than that in the preeclampsia-CEA group （[4.3 - 0.8]min vs. [16.6 ± 2.21 min, P〈0. 01）. But there was no significant difference in intraoperative fluid infusion between the two groups （ P〉0. 05）. Hypotension occurred in.2 patients in the preeclampsia-OSEA group and 4 patients in the preeclampsia-OEA group （P〉0.05）. The baseline SBP and DBP in preeclampsia-OSEA group were significantly higher than those in healthy-OSEA group （ P〈0.01 ）, while the baseline HR is not significantly different （P〉0.05）. There were no significant differences in the decreased HR, SBP and DBP just immediately after anes
出处
《上海医学》
CAS
CSCD
北大核心
2012年第8期663-667,共5页
Shanghai Medical Journal
