摘要
目的比较两种蛛网膜下腔阻滞麻醉(腰麻)方案在高龄产妇剖宫产手术中的应用效果。方法将57例行剖宫产手术的高龄产妇随机分成A组28例和B组29例,A组产妇给予0.75%罗哌卡因注射液复合舒芬太尼注射液混合自身脑脊液稀释麻醉,B组产妇给予0.75%罗哌卡因注射液混合10%葡萄糖注射液稀释麻醉。记录产妇麻醉前(T_0)、蛛网膜下腔注药后3 min(T_3)、5 min(T_5)、10 min(T_(10))、15 min(T_(15))、20 min(T_(20))、30 min(T_(30))的平均动脉压(MAP)和HR,比较两组痛觉阻滞平面评分和达到最高阻滞平面所需的时间、胎儿娩出所需时间、手术时间、新生儿Apgar评分和孕产妇手术结束时痛觉阻滞平面评分、取出胎儿时肌肉松弛效果、手术期间不良反应和麻醉随访并发症的发生情况。结果两组孕产妇围术期各时点的MAP、HR比较,差异均无统计学意义(P>0.05),MAP、HR均无随时间变化的趋势(P>0.05),分组与时间亦无交互效应(P>0.05)。A组痛觉阻滞最高平面评分低于B组(P<0.05),且达到最高痛觉阻滞平面所需时间、胎儿娩出时间、手术时间均短于B组(均P<0.05)。两组患者新生儿Apgar评分及取出胎儿时产妇肌肉松弛效果比较,差异均无统计学意义(P>0.05)。B组术中鼓肠发生率高于A组(P<0.05),但两组术后均未出现与麻醉相关并发症。结论 0.75%罗哌卡因注射液复合舒芬太尼注射液混合自身脑脊液稀释可以作为高龄剖宫产手术腰麻的理想用药方案。
Objective To compare the application effects between the two regimens of spinal analgesia on the pregnant women with advanced maternal age undergoing caesarean section. Methods Fifty-seven pregnant women with advanced maternal age undergoing cesarean section were randomly divided into group A（ n = 28） and group B（ n = 29）. Pregnant women in group A were given anesthesia with diluted solutions of 0. 75% ropivacaine injection combined with sufentanil injection mixed with their own cerebrospinal fluid,and in group B were given anesthesia with diluted solutions of 0. 75% ropivacaine injection mixed with 10% glucose injection. Mean arterial pressure（ MAP） and heart rate（ HR） were recorded before anesthesia（ T0）,after 3（ T3）,5（ T5）,10（ T（10））,15（ T（15））,20（ T（20）） and 30 minutes（ T（30）） of subarachnoid injection,and the score for algesia block level,time to reaching the highest algesia block level,time for childbirth,operation duration,neonatal Apgar scores were compared between the two groups,and the pregnant women＇s score for algesia block level at the end of the operation,effect of muscle relaxation when delivery,and incidences of adverse reactions during operation and complications of anesthesia during follow-up were compared as well. Results There were no statistically significant differences in the MAP or HR at any time point during peri-operation between the two groups（ P 〈0. 05）. Neither MAP nor HR changed with time in the two groups（ P 〈0. 05）,and no interaction effect was observed between group and time（ P 〈0. 05）. The score for the highest algesia block level in group A was lower than that in group B（ P 〈0. 05）,and the time to reaching the highest algesia block level,time for childbirth and operation duration in group A were shorter than those in group B（ P 〈0. 05）. There was no significant difference in the neonatal Apgar score or effect of muscle relaxation on pregnant women when delivery between the two groups（ P 〈0. 05）. The incidence rate of intraoperative intestinal edema in group B was higher than that in group A（ P 〈0. 05）,and no anesthesia-associated complications occurred after operation in the two groups. Conclusion For the pregnant women with advanced maternal age,diluted solutions of 0. 75% ropivacaine injection combined with sufentanil injection mixed with their own cerebrospinal fluid can be used as an ideal medication regimen for lumbar spinal anesthesia during caesarean section.
出处
《广西医学》
CAS
2018年第1期51-54,共4页
Guangxi Medical Journal
关键词
蛛网膜下腔阻滞麻醉
剖宫产
罗哌卡因
舒芬太尼
高龄
Spinal anesthesia, Cesarean section, Ropivacaine, Sufentanil, Advanced maternal age
