CSEA后不同翻平时间对剖宫产麻醉效果的影响
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摘要
目的探讨产妇由左侧卧位调整到平卧位的时间对腰硬联合阻滞麻醉(CSEA)效果的影响。方法在CSEA下择期剖宫产135例,根据翻平时间随机分为3组:A组在CSEA后翻平时间为1min,B组为2.5min,C组为4min。记录:⑴各产妇入室、蛛网膜下腔注射麻醉药后5min及10min各时间点收缩压(SBP)、舒张压(DBP)、心率(HR)、指末梢氧饱和度(SpO_2);⑵蛛网膜下腔注药5min,7min,9min后的痛觉阻滞平面及痛觉阻滞平面达T6 (理想平面)的例数;⑶蛛网膜下腔注药5min,10min,15min后低血压、心动过速发生比例。结果 3组产妇痛觉阻滞平面差异明显(P<0.05);3组产妇各时间点痛觉阻滞平面达T6 (理想平面)的比例有显著差异(P<0.05);3组产妇各时间点SBP、DBP、HR无明显差异(P>0.05);3组产妇各时间点低血压、心动过速等不良事件的发生率没有明显差异(P>0.05)。结论由左侧卧位恢复到平卧位的时间为1min可更快满足手术要求,且不会造成麻醉平面过高的现象。
Objective To investigate the effect of the turning time from left lateral to supine position on the development of block after combined spinal-epidural anesthesia(CSEA) for cesarean section. Methods Total of 135 gravidas undergoing selective cesarean section under CSEA were randomly divided into three groups by the time turning from left lateral to supine position. In group A, the turning time is one minute. In group B, it is 2.5 minute. In group C, it is 4 minute. The systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR), and finger oxygen saturation(SpO_2) of each gravidas were continuously monitored after entering into the operating room. The level of thoracic block at 5min, 7min and 9min after injection of bupivacaine in subarachnoid, and the number of cases with level of T6 were recorded. The incidence of intraoperative hypotension and tachycardia at 5min, 10min and 15min after bupivacaine medication was recorded.Results There was significant difference in thoracic block level of pain among these three groups(P<0.05). There was also significant difference in ratio of thoracic block level of pain at T6 in these groups(P<0.05).There were no significant differences in SBP, DBP, and HR at each time points in all the groups(P>0.05). There was no significant difference in the incidence of adverse events(such as hypotension, tachycardia) at each recording point in these groups(P>0.05). Conclusion The turning time from left lateral to supine position within one minute, as it can make the development of block after CSEA for cesarean section more quickly and does not result in higher level of thoracic block.
Objective To investigate the effect of the turning time from left lateral to supine position on the development of block after combined spinal-epidural anesthesia(CSEA) for cesarean section. Methods Total of 135 gravidas undergoing selective cesarean section under CSEA were randomly divided into three groups by the time turning from left lateral to supine position. In group A, the turning time is one minute. In group B, it is 2.5 minute. In group C, it is 4 minute. The systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR), and finger oxygen saturation(SpO_2) of each gravidas were continuously monitored after entering into the operating room. The level of thoracic block at 5min, 7min and 9min after injection of bupivacaine in subarachnoid, and the number of cases with level of T6 were recorded. The incidence of intraoperative hypotension and tachycardia at 5min, 10min and 15min after bupivacaine medication was recorded.Results There was significant difference in thoracic block level of pain among these three groups(P<0.05). There was also significant difference in ratio of thoracic block level of pain at T6 in these groups(P<0.05).There were no significant differences in SBP, DBP, and HR at each time points in all the groups(P>0.05). There was no significant difference in the incidence of adverse events(such as hypotension, tachycardia) at each recording point in these groups(P>0.05). Conclusion The turning time from left lateral to supine position within one minute, as it can make the development of block after CSEA for cesarean section more quickly and does not result in higher level of thoracic block.
引文
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[6]蒋恩富,杨茹剑,江明娣.腰麻联合硬膜外麻醉剖宫产患者卧位低血压综合征实施体位干预的临床观察[J].基层医学论坛,2017,21(16):2046-2047.
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[8]熊立红,侯志艳,滕金亮.血管活性药物预防剖宫产腰硬联合麻醉后低血压的分析[J].河北北方学院学报(自然科学版),2012,28(6):91-93.
[2]庄心良,曾因明,陈伯銮.现代麻醉学[M].第3版.北京:人民卫生出版社,2013:1313-1314.
[3]陈明全,侯俊,方为,等.剖宫产腰硬联合麻醉不同穿刺点麻醉效果的比较[J].实用医学杂志,2010,26(15):2796-2798.
[4]郭会江,马春梅,谢秋明,等.小剂量甲氧明、麻黄碱联合预防剖宫产腰硬联合麻醉术中低血压的效果[J].中国医药导报,2016,13(31):93-96.
[5]王建珍,杨贺,邓立琴.预防性静脉注射去氧肾上腺素和麻黄碱对腰硬联合麻醉剖宫产产妇及胎儿的影响[J].宁夏医科大学学报,2011,33(11):1026-1028,1039.
[6]蒋恩富,杨茹剑,江明娣.腰麻联合硬膜外麻醉剖宫产患者卧位低血压综合征实施体位干预的临床观察[J].基层医学论坛,2017,21(16):2046-2047.
[7]王韬,高桂兰,朱亮先,等.体位改变引起血压波动在剖宫产腰硬联合麻醉中的应用[J].中国妇幼保健,2017,32(9):1890-1892.
[8]熊立红,侯志艳,滕金亮.血管活性药物预防剖宫产腰硬联合麻醉后低血压的分析[J].河北北方学院学报(自然科学版),2012,28(6):91-93.