摘要
目的:探究七氟烷联合硬膜外麻醉对重度子痫前期剖宫产术效果及对产妇血流动力学及镇痛效果的影响.方法:选取2018年9月-2021年9月本院收治的重度子痫前期行剖宫产术产妇120例,随机数表法分为两组各60例,分别给予硬膜外麻醉(对照组)或七氟烷联合硬膜外麻醉(联合组).比较两组麻醉不同时点血流动力学[收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO_(2))]、术后1、5、15、30min镇痛效果[视觉模拟评分(VAS)]、术后4、8、12、24、48h镇静效果(Ramsay镇静评分)、舒适度[舒适评分法(BCS)],比较两组不良反应发生情况、新生儿Apgar评分和术中出血量.结果:两组SBP、HR组间、时间点及交互比较,DBP组间和交互比较均有差异(均P<0.05),两组DBP时间点比较,SpO_(2)组间、时间点及交互比较均无差异(均P>0.05),联合组T_(2)时SBP、DBP、HR水平,T_(3)时HR水平均低于对照组,对照组T_(2)时SBP、DBP、HR水平,T_(3)时HR水平均高于T0时(均P<0.05);两组VAS评分组间、时间点及交互均有差异,术后1、5、15、30min时联合组VAS评分低于对照组(均P<0.05);两组Ramsay镇静评分时间点比较有差异(P<0.05),组间及交互比较无差异(均P>0.05);两组BCS评分组间、时间点比较有差异(均P<0.05),交互比较无差异(P>0.05);术后4、8、12、24、48h,两组Ramsay镇静、BCS评分水平比较均无差异(均P>0.05);两组不良反应、新生儿Apgar评分和术中出血量均无差异(均P>0.05).结论:七氟烷联合硬膜外麻醉能够有效稳定重度子痫前期剖宫产术产妇血流动力学,镇痛效果更佳,且用药安全.
Objective: To explore the effect of sevoflurane combined with epidural anesthesia during cesarean section of puerperae with severe preeclampsia,and to study its influence on the hemodynamics and analgesic effect of the puerperae.Methods:120 puerperae with severe preeclampsia who wanted cesarean section were selected and were divided into two groups(60 cases in each group)by the random number table method between September 2018 and September 2021.The puerperae in observation group were given sevoflurane combined with epidural anesthesia,while the puerperae in control group were given epidural anesthesia only.The hemodynamics values,such as systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),blood oxygen saturation(SpO_(2))at different analgesic time points,the analgesic effect by Visual Analogue Scale(VAS)in 1,5,15 and 30 min after surgery,and the sedation effect evaluated by Ramsay sedation score in 4,8,12,24 and 48 h after surgery,and comfortable degree evaluated by Bruggrmann Comfort Scale(BCS)of the puerperae were compared between the two groups.The occurrence of adverse reactions,neonatal Apgar score,and intraoperative blood loss of the puerperae were also compared between the two groups.Results:There were significant differences in the values of SBP and HR of the puerperae between the two groups,among different time points,and between the interactions,and there was significant difference in the value DBP of the puerperae between the two groups and between interactions(all P<0.05).There was no significant difference in the value of DBP of the puerperae among different time points,and there was no significant difference in the value SpO2 of the puerperae between the two groups,among different time points,and between interactions(all P>0.05).The values of SBP,DBP,and HR at T_(2),and the HR value at T_(3) of the puerperae in the observation group were significantly lower than those of the puerperae in the control group.The values of SBP,DBP,and HR at T_(2),and the HR value at T_(3) of the puerperae in the control were significantly high than those at T0(all P<0.05).There was significant difference in the VAS score of the puerperae between the two groups,and among different time points.The VAS scores of the puerperae in the observation group at 1,5,15,and 30min after operation were significantly lower than those of the puerperae in the control group(all P<0.05).The Ramsay sedation score of the puerperae in the two groups had significant difference among different time points(P<0.05),but which had no significant difference between the two groups and between the interactions(all P>0.05).The BCS score of the puerperae had significant difference between the two groups and among different time points(all P<0.05),but which had no significant difference between the interactions(P>0.05).There were no significant differences in the scores of Ramsay sedation and BCS of the puerperae in 4,8,12,24,and 48 hours after operation between the two groups(all P>0.05).There were no significant differences in the adverse reactions rate,the neonatal Apgar score,and the intraoperative blood loss of the puerperae between the two groups(all P>0.05).Conclusion:Sevoflurane combined with epidural anesthesia during cesarean section of puerperae with severe preeclampsia can effectively stabilize their hemodynamics,with better analgesic effect and safety.
作者
樊佳
邓成琴
刘芹
何静
FAN Jia;DENG Chengqin;LIU Qin;HE Jing(Suining Central Hospital,Suining,Sichuan Province,629000)
出处
《中国计划生育学杂志》
2022年第10期2253-2257,共5页
Chinese Journal of Family Planning
关键词
剖宫产术
重度子痫前期
硬膜外麻醉
七氟烷
镇痛
血流动力学
不良反应
Cesarean section
Severe preeclampsia
Epidural anesthesia
Sevoflurane
Analgesia
Hemodynamics
Adverse reaction
