腰硬联合麻醉剖腹产术中低血压的预防和护理
|
摘要
目的分析剖腹产手术在联合腰麻-硬膜外麻醉(combined spinal epidural anesthesia,CSEA)下低血压的发生,同时研究腰硬联合麻醉剖腹产术中低血压的预防和护理方法。方法选择2012年6月至2016年6月实施腰硬联合麻醉剖腹产术的产妇300例。按照随机数字表法随机分成研究组和对照组,每组150例。对照组由麻醉师管理,护士开展常规指导护理,研究组除常规管理和护理外,还开展规范、系统化的护理干预,包括心理、行为干预等,并且对患者进行密切观察,发现不良反应及时进行预防处理。比较2组患者手术中低血压不良反应的发生率、症状评分、患者满意度、新生儿1 min、5 min的Apgar评分。结果研究组产妇在手术中低血压发生率显著低于对照组,且研究组产妇"恶心呕吐、疲劳、疼痛"方面的症状评分均低于对照组,护理工作满意度高于对照组,差异有统计学意义(P<0.05);新生儿1 min、5 min Apgar评分研究组明显优于对照组,差异有统计学意义(P<0.05)。结论做好充分的术前术中的护理干预,同时术中密切观察病情,可以有效降低患者在腰硬联合麻醉剖腹产术中的低血压的不良反应发生率,从而最大限度减轻患者痛苦,并促进患者术后的功能恢复,值得临床推广。
Objective To investigate the incidence of hypotension during caesarean section under combined spinal epidural anesthesia( CSEA),and to explore the methods of prevention and nursing of hypotension in spinal epidural combined anesthesia during cesarean section. Methods A total of 300 parturients who underwent caesarean section under CSEA in our hospital from June 2012 to June 2016 were enrolled in the study. according to the random number table method,these parturients were randomly divided into research group( n = 150) and control group( n = 150). The parturients in control group received conventional nursing and management,however,the parturients in research group,on the basis of control group,were treated by normalized and systematized nursing intervention including psychological and behavioral intervention. The incidence of hypotensive adverse reactions,symptom scores,satisfaction degree of patients,Apgar scores of neonates at 1 min,5 min after birth were observed and compared between the two groups. Results The incidence of hypotension during operation in research group was significantly lower than that in control group,and the symptom scores including nausea,vomiting,fatigue and pain in research group were significantly lower than those in control group,moreover,the satisfaction degree of nursing work in research group was significantly higher than that in control group( P < 0. 05). In addition the Apgar scores at 1 min and 5 min in research group were superior to those in control group( P < 0. 05). Conclusion The adequate preoperative and postoperative nursing interventions as well as the close observation of intraoperative conditions can effectively decrease the incidence of hypotension in spinal epidural combined anesthesia during cesarean section,so as to relieve maximatily patient's pain and promote postoperative functional recovery,thus,it is worthy of clinic application.
Objective To investigate the incidence of hypotension during caesarean section under combined spinal epidural anesthesia( CSEA),and to explore the methods of prevention and nursing of hypotension in spinal epidural combined anesthesia during cesarean section. Methods A total of 300 parturients who underwent caesarean section under CSEA in our hospital from June 2012 to June 2016 were enrolled in the study. according to the random number table method,these parturients were randomly divided into research group( n = 150) and control group( n = 150). The parturients in control group received conventional nursing and management,however,the parturients in research group,on the basis of control group,were treated by normalized and systematized nursing intervention including psychological and behavioral intervention. The incidence of hypotensive adverse reactions,symptom scores,satisfaction degree of patients,Apgar scores of neonates at 1 min,5 min after birth were observed and compared between the two groups. Results The incidence of hypotension during operation in research group was significantly lower than that in control group,and the symptom scores including nausea,vomiting,fatigue and pain in research group were significantly lower than those in control group,moreover,the satisfaction degree of nursing work in research group was significantly higher than that in control group( P < 0. 05). In addition the Apgar scores at 1 min and 5 min in research group were superior to those in control group( P < 0. 05). Conclusion The adequate preoperative and postoperative nursing interventions as well as the close observation of intraoperative conditions can effectively decrease the incidence of hypotension in spinal epidural combined anesthesia during cesarean section,so as to relieve maximatily patient's pain and promote postoperative functional recovery,thus,it is worthy of clinic application.
引文
[1]田航,李新宇,程秋菊,等.腰硬联合麻醉下剖宫产术中去氧肾上腺素与羟乙基淀粉即时扩容对产妇血流动力学及胎儿酸碱值的影响.河北医学,2017,15:572-576.
2 林远贵,江晓琴.持续去氧肾上腺素静脉泵注与单次给药对腰硬联合麻醉下剖宫产产妇及新生儿的影响.华西医学,2017,22:727-730.
3 刘纳新,黄杏琼,江金环,等.不同方式腰硬联合麻醉剖宫产患者术后自控镇痛效应的比较.广东医学,2015,36:712-714.
4 邢均.腰硬联合麻醉用于二次剖宫产手术的麻醉效果观察.现代中西医结合杂志,2014,23:1909-1910.
5 刘延东,张亚栋,郝瑞娟.硬膜外腔注射氢吗啡酮联合静脉镇痛在剖腹产术后的应用.世界最新医学信息文摘,2016,16:175-176.
6 袁凤玲.妊娠高血压疾病剖宫产术不同麻醉方式的临床效果研究.中国医药指南,2015,13:178-178.
7 朱建坡,伦巍巍.剖宫产腰硬联合麻醉中低血压的影响因素及其防治方法.重庆医学,2017,15:275-277.
8 杨杰,黄忠义,吴艳琴.腰硬联合麻醉在剖宫产术中的应用与比较.安徽医药,2010,14:1457-1458.
9 黄青云,刘佩蓉.小剂量舒芬太尼在剖宫产术腰硬联合麻醉中的临床应用.中国妇幼保健,2017,32:4546-4548.
10 黄敏,区少梅,邓美芳.腰硬联合麻醉与气管插管全身麻醉对剖宫产手术新生儿呼吸的影响.中国当代医药,2017,24:47-49.
11 廖小谊,何文华,伍梅珍,等.个性化麻醉护理对罗哌卡因腰硬联合麻醉剖宫产镇痛中的应用.中国医药科学,2017,5:110-112.
12 杨静,勾宝华.体位护理预防腰硬联合麻醉下剖宫产术致仰卧位综合征的效果.中华现代护理杂志,2016,22:2295-2297.
13 施如光,陈慧姻,李如洁.腰硬联合麻醉中不同麻醉体位对剖宫产产妇及其新生儿的影响分析.中医临床研究,2017,9:147-148.
14 田庆荣,张进香.不同穿刺间隙腰硬联合麻醉的剖宫产麻醉效果比较.医学理论与实践,2017,30:93-94.
15 王晓莉.输注不同容量胶体对腰硬联合麻醉下剖宫产产妇循环功能的影响.青岛大学,2014.
16 陈郡兴,蓝绮云,靳三庆,等.剖宫产腰硬联合麻醉中低血压的影响因素及其防治方法.中华产科急救电子杂志,2014,3:64-68.
17 D’Ambrosio A,Spadaro A,Mirabella L,et al.The anaesthetic and recovery profile of two concentrations(0.25%and 0.50%),of intrathecal isobaric levobupivacaine for combined spinal-epidural(CSE)anaesthesia in patients undergoing modified Stark method caesarean delivery:a double blinded randomized trial.Eur Revi Medi Pharmacol Sci,2013,17:3229-3236.
18 Mi HL,Eun MK,Jun HB,et al.Head Elevation in Spinal-Epidural Anesthesia Provides Improved Hemodynamics and Appropriate Sensory Block Height at Caesarean Section.Yonsei Med J,2015,56:1122-1127.
19 Xu ZD,Shen FY,Zhang YQ,et al.Combined spinal-epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section.J Obstet Gynaecol Res,2017,43:669-675.
20 Moore A,El-Mouallem E,El-Bahrawy A,et al.An up-down determination of the required seated duration after intrathecal injection of bupivacaine and fentanyl for the prevention of hypotension during Cesarean delivery.Can J Anesth,2017,64:1002-1008.
21 郭洪勋.腰硬联合麻醉体位变化对剖宫产孕妇血液动力学的影响分析.中国医药指南,2017,15:138-139.
2 林远贵,江晓琴.持续去氧肾上腺素静脉泵注与单次给药对腰硬联合麻醉下剖宫产产妇及新生儿的影响.华西医学,2017,22:727-730.
3 刘纳新,黄杏琼,江金环,等.不同方式腰硬联合麻醉剖宫产患者术后自控镇痛效应的比较.广东医学,2015,36:712-714.
4 邢均.腰硬联合麻醉用于二次剖宫产手术的麻醉效果观察.现代中西医结合杂志,2014,23:1909-1910.
5 刘延东,张亚栋,郝瑞娟.硬膜外腔注射氢吗啡酮联合静脉镇痛在剖腹产术后的应用.世界最新医学信息文摘,2016,16:175-176.
6 袁凤玲.妊娠高血压疾病剖宫产术不同麻醉方式的临床效果研究.中国医药指南,2015,13:178-178.
7 朱建坡,伦巍巍.剖宫产腰硬联合麻醉中低血压的影响因素及其防治方法.重庆医学,2017,15:275-277.
8 杨杰,黄忠义,吴艳琴.腰硬联合麻醉在剖宫产术中的应用与比较.安徽医药,2010,14:1457-1458.
9 黄青云,刘佩蓉.小剂量舒芬太尼在剖宫产术腰硬联合麻醉中的临床应用.中国妇幼保健,2017,32:4546-4548.
10 黄敏,区少梅,邓美芳.腰硬联合麻醉与气管插管全身麻醉对剖宫产手术新生儿呼吸的影响.中国当代医药,2017,24:47-49.
11 廖小谊,何文华,伍梅珍,等.个性化麻醉护理对罗哌卡因腰硬联合麻醉剖宫产镇痛中的应用.中国医药科学,2017,5:110-112.
12 杨静,勾宝华.体位护理预防腰硬联合麻醉下剖宫产术致仰卧位综合征的效果.中华现代护理杂志,2016,22:2295-2297.
13 施如光,陈慧姻,李如洁.腰硬联合麻醉中不同麻醉体位对剖宫产产妇及其新生儿的影响分析.中医临床研究,2017,9:147-148.
14 田庆荣,张进香.不同穿刺间隙腰硬联合麻醉的剖宫产麻醉效果比较.医学理论与实践,2017,30:93-94.
15 王晓莉.输注不同容量胶体对腰硬联合麻醉下剖宫产产妇循环功能的影响.青岛大学,2014.
16 陈郡兴,蓝绮云,靳三庆,等.剖宫产腰硬联合麻醉中低血压的影响因素及其防治方法.中华产科急救电子杂志,2014,3:64-68.
17 D’Ambrosio A,Spadaro A,Mirabella L,et al.The anaesthetic and recovery profile of two concentrations(0.25%and 0.50%),of intrathecal isobaric levobupivacaine for combined spinal-epidural(CSE)anaesthesia in patients undergoing modified Stark method caesarean delivery:a double blinded randomized trial.Eur Revi Medi Pharmacol Sci,2013,17:3229-3236.
18 Mi HL,Eun MK,Jun HB,et al.Head Elevation in Spinal-Epidural Anesthesia Provides Improved Hemodynamics and Appropriate Sensory Block Height at Caesarean Section.Yonsei Med J,2015,56:1122-1127.
19 Xu ZD,Shen FY,Zhang YQ,et al.Combined spinal-epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section.J Obstet Gynaecol Res,2017,43:669-675.
20 Moore A,El-Mouallem E,El-Bahrawy A,et al.An up-down determination of the required seated duration after intrathecal injection of bupivacaine and fentanyl for the prevention of hypotension during Cesarean delivery.Can J Anesth,2017,64:1002-1008.
21 郭洪勋.腰硬联合麻醉体位变化对剖宫产孕妇血液动力学的影响分析.中国医药指南,2017,15:138-139.