腰硬膜外联合麻醉在高龄剖宫产手术中的应用研究
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摘要
目的探讨高龄剖宫产手术中采取腰硬膜外联合麻醉的应用价值。方法随机抽取2016年1月-2018年1月期间60例高龄剖宫产患者,按照随机数表法分为联合组与持续组各30例。持续组患者采取持续硬膜外麻醉方案处理,而联合组则采取腰硬膜外联合麻醉方案处理。测定麻醉前、麻醉后、手术牵拉反应时两组患者心率、收缩压、舒张压情况,并记录麻醉效果(起效时间、镇痛维持时间)、不良反应情况。结果两组患者在麻醉前心率、收缩压、舒张压对比差异无统计学意义(P>0.05),麻醉后与手术牵拉反应时联合组患者收缩压与舒张压低于持续组,差异有统计学意义(P<0.05);联合组在手术牵拉反应时心率低于持续组,差异有统计学意义(P<0.05);联合组患者麻醉起效时间短于持续组,且镇痛维持时间长于持续组,差异均有统计学意义(P<0.05);联合组不良反应总发生率低于持续组,差异有统计学意义(P<0.05)。结论腰硬膜外联合麻醉应用于高龄剖宫产产妇具有较高的安全性,且麻醉起效时间更短,镇痛维持时间更长,值得借鉴。
Objective To investigate the application of lumbar epidural combined anesthesia in cesarean section. Methods 60 elderly patients with cesarean section from January 2016 to January 2018 were selected and divided into 30 groups according to the random number table. The patients in the continuous group were treated with a continuous epidural anesthesia protocol, while the combined group was treated with a combined lumbar epidural anesthesia protocol. The heart rate, systolic blood pressure, and diastolic blood pressure of the two groups were measured before anesthesia, after anesthesia, and during the traction response. The anesthetic effects(onset time, analgesic duration)and adverse reactions were recorded.Results There was no significant difference in heart rate, systolic blood pressure, and diastolic pressure between the two groups before and after anesthesia(P>0.05). There was a significant difference between systolic blood pressure and diastolic blood pressure and continuous group in the combined group after anesthesia and surgical pulling(P<0.05).At the same time, the heart rate was significantly different from the continuous group in the traction response of the combined group(P<0.05); the onset time of anesthesia in the combined group was significantly shorter than the continuous group(P<0.05), and the duration of analgesia was significantly longer than continuous Group(P<0.05); The total incidence of adverse reactions in the combined group was significantly lower than the continuous group(P <0.05). Conclusions The combined use of epidural and epidural anesthesia for the elderly in cesarean section had a higher safety, and the onset time of anesthesia was shorter and the duration of analgesia was longer, which was worth learning from.
Objective To investigate the application of lumbar epidural combined anesthesia in cesarean section. Methods 60 elderly patients with cesarean section from January 2016 to January 2018 were selected and divided into 30 groups according to the random number table. The patients in the continuous group were treated with a continuous epidural anesthesia protocol, while the combined group was treated with a combined lumbar epidural anesthesia protocol. The heart rate, systolic blood pressure, and diastolic blood pressure of the two groups were measured before anesthesia, after anesthesia, and during the traction response. The anesthetic effects(onset time, analgesic duration)and adverse reactions were recorded.Results There was no significant difference in heart rate, systolic blood pressure, and diastolic pressure between the two groups before and after anesthesia(P>0.05). There was a significant difference between systolic blood pressure and diastolic blood pressure and continuous group in the combined group after anesthesia and surgical pulling(P<0.05).At the same time, the heart rate was significantly different from the continuous group in the traction response of the combined group(P<0.05); the onset time of anesthesia in the combined group was significantly shorter than the continuous group(P<0.05), and the duration of analgesia was significantly longer than continuous Group(P<0.05); The total incidence of adverse reactions in the combined group was significantly lower than the continuous group(P <0.05). Conclusions The combined use of epidural and epidural anesthesia for the elderly in cesarean section had a higher safety, and the onset time of anesthesia was shorter and the duration of analgesia was longer, which was worth learning from.
引文
[1]刘欣,姜山,孔繁丽,等.超声引导下腹横肌平面阻滞用于剖宫产腰麻硬膜外联合麻醉时术中及术后效果观察[J].临床外科杂志,2016,24(8):629-632.
[2]聂丽霞,王翔,刘保江,等.不同剂量甲氧明与麻黄碱联合预注对剖宫产母婴的影响[J].国际麻醉学与复苏杂志,2015,36(5):412-416.
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[5]劳建新,宋兴荣,张永福,等.硬膜穿孔后硬膜外镇痛在分娩镇痛中的应用[J].临床麻醉学杂志,2012,28(5):448-450.
[6]王志华,欧阳碧山,陈勇,等.氯普鲁卡因复合吗啡硬膜外麻醉对剖宫产术后镇痛的影响[J].临床麻醉学杂志,2015,31(8):810-811.
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[8]Kalava,A,Darji,S.J,Kalstein,A.et al.Efficacy of ginger on intraoperative and postoperative nausea and vomiting in elective cesarean section patients[J].European Journal of Obstetrics,Gynecology and Reproductive Biology:An International Journal,2013,169(2):184-188.
[9]Kessous,R,Tirosh,D,Weintraub,A.Y.et al.Second stage disorders in patients following a previous cesarean section:Vacuum versus repeated cesarean section[J].Archives of gynecology and obstetrics,2013,287(6):1075-1079.
[10]Pacher,J,Brix,E,Lehner,R.et al.The mode of delivery in patients with preeclampsia at term subject to elective or emergency Cesarean section[J].Archives of gynecology and obstetrics,2014,289(2):263-267.
[11]张世强,刘宏飞,马宏.腰硬膜外联合麻醉和持续硬膜外麻醉在高龄剖宫产手术中的应用[J].中南医学科学杂志,2017,45(6):601-604.
[12]朱洲.二次剖宫产术腰硬膜外联合麻醉和持续硬膜外麻醉方法对比观察[J].深圳中西医结合杂志,2017,27(4):158-159.
[13]王毅,彭国庆.二次剖宫产术中应用腰硬膜外联合麻醉与持续硬膜外麻醉的效果对比分析[J].中国继续医学教育,2016,8(28):52-53.
[14]刘绍琼.腰硬膜外联合麻醉和持续硬膜外麻醉在二次剖宫产手术中的临床价值[J].深圳中西医结合杂志,2016,26(12):115-116.
[15]颜文秀.小剂量布比卡因腰硬膜联合麻醉用于老年患者下肢骨折手术临床观察[J].中国卫生产业,2014,11(25):31-32.
[16]冷丽红,丁少伟.腰硬膜外联合麻醉和持续硬膜外麻醉用于二次剖宫产术的效果比较[J].当代医学,2013,19(27):77-78.
[17]黄格,谭冠先,叶海洪,等.6%羟乙基淀粉共同负荷联合麻黄碱预防高龄产妇剖宫产术硬膜外麻醉后低血压的观察[J].海南医学,2012,23(24):48-50.
[18]李德学.剖宫产手术中腰、硬膜外联合麻醉和持续硬膜外麻醉效果探索[J].河南外科学杂志,2012,18(6):62-63.
[19]陈赛,杨军.全身麻醉在高龄妊娠产妇剖宫产术中的应用分析[J].现代医药卫生,2017,33(19):2909-2911.
[20]陈铭,谭熠.高龄妊娠合并血小板减少症剖宫产术不同麻醉方法的临床分析[J].现代医药卫生,2017,33(19):2904-2906.
[21]柳柏林.肥胖、高血压高龄产妇剖宫产麻醉方法的临床研究[J].实用妇科内分泌电子杂志,2015,2(3):184,186.
[22]李艳玲.三种麻醉方法在高危高龄产妇剖宫产手术中的临床比较[J].实用妇科内分泌电子杂志,2014,1(7):47-48.
[23]熊其强.对进行剖宫产的高龄产妇实施腰硬联合麻醉的效果观察[J].当代医药论丛,2014,12(8):234-235.
[2]聂丽霞,王翔,刘保江,等.不同剂量甲氧明与麻黄碱联合预注对剖宫产母婴的影响[J].国际麻醉学与复苏杂志,2015,36(5):412-416.
[3]李铁军,马飞,曾德茁,等.布比卡因用于硬膜外液体预充的剖宫产术患者腰麻的适宜剂量[J].中华麻醉学杂志,2016,36(2):192-195.
[4]陈朝辉,向太,高勤,等.罗哌卡因混合舒芬太尼用于剖宫产术患者腰麻的半数有效剂量[J].中华麻醉学杂志,2011,31(5):583-585.
[5]劳建新,宋兴荣,张永福,等.硬膜穿孔后硬膜外镇痛在分娩镇痛中的应用[J].临床麻醉学杂志,2012,28(5):448-450.
[6]王志华,欧阳碧山,陈勇,等.氯普鲁卡因复合吗啡硬膜外麻醉对剖宫产术后镇痛的影响[J].临床麻醉学杂志,2015,31(8):810-811.
[7]耿志宇,王东信.剖宫产术患者不同比重罗哌卡因腰麻半数有效剂量的比较[J].中华麻醉学杂志,2011,31(7):822-823.
[8]Kalava,A,Darji,S.J,Kalstein,A.et al.Efficacy of ginger on intraoperative and postoperative nausea and vomiting in elective cesarean section patients[J].European Journal of Obstetrics,Gynecology and Reproductive Biology:An International Journal,2013,169(2):184-188.
[9]Kessous,R,Tirosh,D,Weintraub,A.Y.et al.Second stage disorders in patients following a previous cesarean section:Vacuum versus repeated cesarean section[J].Archives of gynecology and obstetrics,2013,287(6):1075-1079.
[10]Pacher,J,Brix,E,Lehner,R.et al.The mode of delivery in patients with preeclampsia at term subject to elective or emergency Cesarean section[J].Archives of gynecology and obstetrics,2014,289(2):263-267.
[11]张世强,刘宏飞,马宏.腰硬膜外联合麻醉和持续硬膜外麻醉在高龄剖宫产手术中的应用[J].中南医学科学杂志,2017,45(6):601-604.
[12]朱洲.二次剖宫产术腰硬膜外联合麻醉和持续硬膜外麻醉方法对比观察[J].深圳中西医结合杂志,2017,27(4):158-159.
[13]王毅,彭国庆.二次剖宫产术中应用腰硬膜外联合麻醉与持续硬膜外麻醉的效果对比分析[J].中国继续医学教育,2016,8(28):52-53.
[14]刘绍琼.腰硬膜外联合麻醉和持续硬膜外麻醉在二次剖宫产手术中的临床价值[J].深圳中西医结合杂志,2016,26(12):115-116.
[15]颜文秀.小剂量布比卡因腰硬膜联合麻醉用于老年患者下肢骨折手术临床观察[J].中国卫生产业,2014,11(25):31-32.
[16]冷丽红,丁少伟.腰硬膜外联合麻醉和持续硬膜外麻醉用于二次剖宫产术的效果比较[J].当代医学,2013,19(27):77-78.
[17]黄格,谭冠先,叶海洪,等.6%羟乙基淀粉共同负荷联合麻黄碱预防高龄产妇剖宫产术硬膜外麻醉后低血压的观察[J].海南医学,2012,23(24):48-50.
[18]李德学.剖宫产手术中腰、硬膜外联合麻醉和持续硬膜外麻醉效果探索[J].河南外科学杂志,2012,18(6):62-63.
[19]陈赛,杨军.全身麻醉在高龄妊娠产妇剖宫产术中的应用分析[J].现代医药卫生,2017,33(19):2909-2911.
[20]陈铭,谭熠.高龄妊娠合并血小板减少症剖宫产术不同麻醉方法的临床分析[J].现代医药卫生,2017,33(19):2904-2906.
[21]柳柏林.肥胖、高血压高龄产妇剖宫产麻醉方法的临床研究[J].实用妇科内分泌电子杂志,2015,2(3):184,186.
[22]李艳玲.三种麻醉方法在高危高龄产妇剖宫产手术中的临床比较[J].实用妇科内分泌电子杂志,2014,1(7):47-48.
[23]熊其强.对进行剖宫产的高龄产妇实施腰硬联合麻醉的效果观察[J].当代医药论丛,2014,12(8):234-235.