26号针腰麻和腰硬联合麻醉在剖宫产手术中的应用效果比较
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摘要
目的比较26号针腰麻(SA)和腰硬联合麻醉(CSEA)在剖宫产手术中的应用效果。方法选取2018年1～6月我院收治的拟进行剖宫产的100例孕妇作为研究对象,采用随机数字表法将其分为SA组(50例)和CSEA组(50例)。SA组采用26号针进行SA,CSEA组采用常规CSEA,比较两组的麻醉起效时间、感觉阻滞恢复时间、运动阻滞恢复时间、麻醉优良率、麻醉前后血压(收缩压、舒张压)和心率及不良反应发生情况。结果 CSEA组的麻醉起效时间、感觉阻滞恢复时间、运动阻滞恢复时间均显著短于SA组,差异有统计学意义(P<0.05)。CSEA组的优良率为92.00%,与SA组的90.00%比较,差异无统计学意义(P>0.05)。两组麻醉前的收缩压、舒张压、心率比较,差异无统计学意义(P>0.05);两组麻醉后的收缩压、舒张压均低于麻醉前,差异有统计学意义(P<0.05);两组麻醉前后的心率比较,差异无统计学意义(P>0.05);SA组麻醉后的收缩压高于CSEA组,差异有统计学意义(P<0.05);两组麻醉后的舒张压、心率比较,差异无统计学意义(P>0.05)。SA组的不良反应总发生率为4.00%,显著低于CSEA组的26.00%,差异有统计学意义(P<0.05)。结论 26号针SA及CSEA均符合剖宫产麻醉要求,CSEA具有更好的时间控制性,26号针SA对产妇循环影响及麻醉的不良反应更小,临床工作中应根据情况合理选择。
Objective To compare the application effect bewteen spinal anesthesia(SA) with No. 26 LP needle and combined spinal-epidural anesthesia(CSEA) in cesarean section. Methods From January to June 2018, a total of 100 pregnant women who intended to undergo cesarean section in our hospital were selected as research objects and divided into SA group(50 cases) and CSEA group(50 cases) according to the random number table method. The SA group received SA with No. 26 LP needle, and the CSEA group received CSEA. The onset time of anesthesia, sensory block recovery time, exercise block recovery time, excellent and good rate of anesthesia, blood pressure(systolic blood pressure,diastolic blood pressure), and heart rate before and after anesthesia and adverse reactions were compared bewteen the two groups. Results The onset time of anesthesia, sensory block recovery time and exercise block recovery time in the CSEA group were significantly shorter than those in the SA group, and the differences were statistically significant(P<0.05). The excellent and good rate of anesthesia in the CSEA group was 92.00%, compared with 90.00% in the SA group, and the difference was not statistically significant(P >0.05). There were no significant differences in systolic blood pressure, diastolic blood pressure and heart rate between the two groups before anesthesia(P>0.05). The systolic and diastolic blood pressures after anesthesia of the two groups were lower than those before anesthesia, and the differences were statistically significant(P<0.05). There was no significant difference in heart rate between the two groups before and after anesthesia(P>0.05). The systolic blood pressure after anesthesia in the SA group was higher than that in the CSEA group, and the difference was statistically significant(P<0.05). There were no significant differences in pressure and heart rate between the two groups after anesthesia(P>0.05). The total incidence rate of adverse reactions in the SA group was 4.00%, which was significantly lower than that in the CSEA group accounting for 26.00%, and the difference was statistically significant(P<0.05). Conclusions Both SA with No. 26 LP needle and CSEA meet the anesthesia requirements of cesarean section. CSEA has a better time control, SA with No. 26 LP needle has less impact on maternal circulation and fewer adverse reactions, which should be reasonably selected according to the situation.
Objective To compare the application effect bewteen spinal anesthesia(SA) with No. 26 LP needle and combined spinal-epidural anesthesia(CSEA) in cesarean section. Methods From January to June 2018, a total of 100 pregnant women who intended to undergo cesarean section in our hospital were selected as research objects and divided into SA group(50 cases) and CSEA group(50 cases) according to the random number table method. The SA group received SA with No. 26 LP needle, and the CSEA group received CSEA. The onset time of anesthesia, sensory block recovery time, exercise block recovery time, excellent and good rate of anesthesia, blood pressure(systolic blood pressure,diastolic blood pressure), and heart rate before and after anesthesia and adverse reactions were compared bewteen the two groups. Results The onset time of anesthesia, sensory block recovery time and exercise block recovery time in the CSEA group were significantly shorter than those in the SA group, and the differences were statistically significant(P<0.05). The excellent and good rate of anesthesia in the CSEA group was 92.00%, compared with 90.00% in the SA group, and the difference was not statistically significant(P >0.05). There were no significant differences in systolic blood pressure, diastolic blood pressure and heart rate between the two groups before anesthesia(P>0.05). The systolic and diastolic blood pressures after anesthesia of the two groups were lower than those before anesthesia, and the differences were statistically significant(P<0.05). There was no significant difference in heart rate between the two groups before and after anesthesia(P>0.05). The systolic blood pressure after anesthesia in the SA group was higher than that in the CSEA group, and the difference was statistically significant(P<0.05). There were no significant differences in pressure and heart rate between the two groups after anesthesia(P>0.05). The total incidence rate of adverse reactions in the SA group was 4.00%, which was significantly lower than that in the CSEA group accounting for 26.00%, and the difference was statistically significant(P<0.05). Conclusions Both SA with No. 26 LP needle and CSEA meet the anesthesia requirements of cesarean section. CSEA has a better time control, SA with No. 26 LP needle has less impact on maternal circulation and fewer adverse reactions, which should be reasonably selected according to the situation.
引文
[1]冯俊英,邹芳铭.二胎政策开放对剖宫产率的影响及相关影响因素探究[J].山西医药杂志,2017,46(21):2611-2614.
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[9]刘琼,孟磊,李丽娜,等.腰麻-硬膜外联合麻醉(CSEA)和硬膜外麻醉(EA)在急诊剖宫产术中的应用效果[J].当代医药论丛,2013,11(11):74-75.
[10]赖玮宏,许铿.26号针腰麻与腰硬联合麻醉在剖宫产手术中麻醉效果比较[J].中国医师杂志,2017,19(5):772-774.
[11]刘小彪,陈笠雄,马家滟,等.罗哌卡因与布比卡因在剖宫产手术腰-硬联合麻醉中效果[J].牡丹江医学院学报,2016,37(2):75-77.
[12]肖伟杰,房特.CSEA剖宫产患者仰卧位低血压综合征的体位干预[J].中国继续医学教育,2017,9(26):163-164.
[13]尹艳,李素芳,付勤,等.儿童腰椎穿刺术后不同平卧时间对头痛、腰背痛及脑脊液渗出量的影响[J].广东医学,2013,34(12):1882-1884.
[14]高华林,魏本忠.25G细针腰麻在老年患者麻醉中的应用分析[J].中外医疗,2017,36(26):36-37,76.
[15]郭善亮,刘小兵,周绪峰,等.25G脊麻针单穿腰麻在急诊剖宫产中的应用[J].实用临床医学,2014,15(7):46.
[2]王浩,彰宁.不同麻醉方式在剖宫产术中的麻醉效能及对产妇血流动力学的影响[J].中国妇幼保健,2017,32(21):5466-5469.
[3]杨敏,薛荣亮.腰硬联合麻醉用于妇产科手术后并发症的临床观察[J].陕西医学杂志,2016,45(12):1590-1591.
[4]方军,王胜斌.L3~4间隙25G细针不同入路单次腰麻用于剖宫产术的临床研究[J].贵州医科大学学报,2015,40(10):1135-1138.
[5]王凤霞.腰硬联合麻醉用于急诊剖宫产手术的安全性评价[J].当代医学,2016,22(30):59-60.
[6]董丽萍,蔡莉,刘虹,等.腰硬联合麻醉应用于无痛分娩的疗效及安全性分析[J].中国现代医学杂志,2015,25(3):91-93.
[7]张茂鹏,刘伟,刘浩东.腰-硬联合麻醉加入微量右美托咪定用于择期剖宫产手术的麻醉效果分析[J].实用药物与临床,2016,19(8):968-972.
[8]张春霞.25G细针小剂量布比卡因腰麻在肛肠科手术中的应用效果及安全性研究[J].中国医学创新,2016,13(23):117-120.
[9]刘琼,孟磊,李丽娜,等.腰麻-硬膜外联合麻醉(CSEA)和硬膜外麻醉(EA)在急诊剖宫产术中的应用效果[J].当代医药论丛,2013,11(11):74-75.
[10]赖玮宏,许铿.26号针腰麻与腰硬联合麻醉在剖宫产手术中麻醉效果比较[J].中国医师杂志,2017,19(5):772-774.
[11]刘小彪,陈笠雄,马家滟,等.罗哌卡因与布比卡因在剖宫产手术腰-硬联合麻醉中效果[J].牡丹江医学院学报,2016,37(2):75-77.
[12]肖伟杰,房特.CSEA剖宫产患者仰卧位低血压综合征的体位干预[J].中国继续医学教育,2017,9(26):163-164.
[13]尹艳,李素芳,付勤,等.儿童腰椎穿刺术后不同平卧时间对头痛、腰背痛及脑脊液渗出量的影响[J].广东医学,2013,34(12):1882-1884.
[14]高华林,魏本忠.25G细针腰麻在老年患者麻醉中的应用分析[J].中外医疗,2017,36(26):36-37,76.
[15]郭善亮,刘小兵,周绪峰,等.25G脊麻针单穿腰麻在急诊剖宫产中的应用[J].实用临床医学,2014,15(7):46.