摘要
目的探讨不同硬膜外导管置管长度对中转剖宫产产妇硬膜外麻醉成功率的影响。方法纳入2022年12月—2023年11月在连云港市妇幼保健院接受椎管内阻滞分娩镇痛且中转剖宫产的产妇。本研究选取985例接受分娩镇痛的产妇,随机分为3组,分别在超声引导下置入腰椎第二椎体长度(L组,320例)、第二椎体长度+1 cm(L+1组,332例)、第二椎体长度+2 cm(L+2组,333例)的硬膜外导管。研究共收集150例中转剖宫产产妇,最终入组情况为:L组42例,L+1组47例,L+2组48例。主要观察指标为中转后硬膜外麻醉的成功率,次要观察指标为产妇分娩镇痛期间的镇痛效果、运动能力、新生儿Apgar评分、术后24 h不良反应、满意度等。结果与L、L+2组相比,L+1组产妇中转后硬膜外麻醉成功率最高,差异有统计学意义(P<0.05)。与L组相比,L+2组产妇手术开始时低血压发生率更高,差异有统计学意义(P<0.05)。3组产妇中转剖宫产前疼痛数字评分量表(NRS)评分、Bromage评分分级、产妇循环情况,中转后新生儿Apgar评分、术后24 h不良反应、满意度差异均无统计学意义(P>0.05)。Spearman相关性分析显示中转后产妇硬膜外成功率与脱管率、BMI均呈成负相关(P<0.05),脱管率与BMI呈正相关(P<0.05)。结论对接受椎管内阻滞分娩镇痛的产妇硬膜外置入第二椎体长度+1 cm硬膜外导管可提高中转剖宫产时硬膜外麻醉成功率;置入第二椎体长度+2 cm硬膜外导管可提高中转手术开始时低血压发生率。中转后产妇硬膜外成功率与脱管率、BMI均呈负相关;脱管率与BMI呈正相关。
Objective To explore the effect of different epidural catheter length on the success rate of epidural anesthesia in women who delivered cesarean section.Methods The women who received intraderinal block labor analgesia and cesarean section in Lianyungang Maternal and Child Health Hospital from December 2022 to November 2023 were included.In this study,985 women receiving labor analgesia were randomly divided into 3 groups.Ultrasus-guided epidural catheter with second vertebral length(group L),second vertebral length+1cm(group L+1),and second vertebral length+2cm(group L+2)were implanted respectively.The main outcome measures were the success rate of epidural anesthesia after transfer,while the secondary outcome measures were analgesic effect during delivery,exercise ability,neonatal Apgar score,postoperative adverse reactions 24 hours,satisfaction,etc.Results A total of 150 cases of women who delivered cesarean section were collected.Compared with L and L+2 groups,the success rate of epidural anesthesia in L+1 group was the highest,and the difference was statistically significant(P<0.05).Compared with L group,the incidence of hypotension at the beginning of operation was higher in L+2 group,and the difference was statistically significant(P<0.05).There were no significant differences in Numeric Rating Scale(NRS),Bromage score,maternal circulation,Apgar score of newborns after transfer,adverse reactions 24h after operation and satisfaction among the three groups(P>0.05).Spearman correlation analysis showed that the epidural success rate of post-con version parturients was negatively correlated with the extubation rate and negatively correlation with the BMI.The dropout rate is positively correlated with BMI.Conclusion Epidural insertion of a second vertebral length+1cm epidural catheter can improve the success rate of epidural anesthesia during caesarean section.The placement of a second vertebral length+2cm epidural catheter increased the incidence of hypotension at the beginning of conversion surgery.The success rate of epidural surgery in parturients was negatively correlated with the extubation with BMI.The dropout rate is positively correlated with BMI.
作者
朱晋娴
颜建娥
李雪
张小宝
ZHU Jinxian;YAN Jian'e;LI Xue;ZHANG Xiaobao(The Affiliated Lianyungang Hospital of Xuzhou Medical University,Lianyungang 222006,Jiangsu,China;Lianyungang Maternal and Child Health Hospital,Lianyungang 222006,Jiangsu,China)
出处
《西部医学》
2025年第8期1180-1184,共5页
Medical Journal of West China
基金
连云港市科技局课题(JCYJ2305)。
