CAJ | 학술논문

目的研究预负荷输液联合小剂量腰硬联合麻醉是否可降低剖宫产手术中产妇心血管系统并发症的发生率.方法剖宫产手术病人随机分为4组,每组30人:晶体液预负荷+腰麻组(CR-SA),胶体液预负荷+腰麻组(CO-SA),晶体液预负荷+小剂量腰硬联合麻醉组(CR-CSEA),胶体液预负荷+小剂量腰硬联合麻醉组(CO-CSEA);预负荷输注乳酸钠林格氏液或琥珀酰明胶注射液500 ml;腰麻为:0.5%布比卡因7.5 mg+芬太尼15μg,小剂量腰硬联合麻醉为:0.5%布比卡因5 mg+芬太尼15μg腰麻,5 min后硬膜外给予0.25%布比卡因10 ml;比较各组术中发生低血压、心律失常、恶心、呕吐、寒战的发生率以及麻黄素的用药量差异;比较各组麻醉感觉最高阻滞平面、Bromage评分、腹肌松弛优等率以及新生儿出生后1 min、5min的Apgar评分和出生即刻的脐动脉血气分析值的差异.结果 CO-CSEA组产妇术中低血压发生率为16.7%,显著低于CR-SA组(46.7%),CO-CSEA组与CO-SA组(20.0%)和CR·CSEA组(26.7%)相比,低血压发生率有降低趋势,但无统计学意义;CO-CSEA组产妇术中心律失常发生率为3.3%,显著低于CR-SA组(33.3%)和CO-SA组(23.3%),但与CR.CSEA组(10.0%)比较无统计学意义;CO-CSEA组与CR-SA组相比,产妇术中麻黄素用药量显著减少;CO-CSEA组和CO-SA组恶心、呕吐的发生率显著低于CR-SA组;各组寒战反应发生率都较低,无统计学差异;各组病人麻醉感觉阻滞平面、Bromage评分、腹肌松弛优等率均无统计学差异,新生儿Apgar评分和脐动脉血气分析值也均在正常范围,无统计学差异.结论预负荷输注胶体液与小剂量腰硬联合麻醉方法联合应用,可有效增强产妇术中心血管系统的稳定性,降低低血压和心律失常的发生率,并可减少术中恶心、呕吐等副作用的发生.
목적 연구예부하수액연합소제량요경연합마취시부가강저부궁산수술중산부심혈관계통병발증적발생솔.방법 부궁산수술병인수궤분위4조,매조30인:정체액예부하+요마조(CR-SA),효체액예부하+요마조(CO-SA),정체액예부하+소제량요경연합마취조(CR-CSEA),효체액예부하+소제량요경연합마취조(CO-CSEA);예부하수주유산납림격씨액혹호박선명효주사액500 ml;요마위:0.5%포비잡인7.5 mg+분태니15μg,소제량요경연합마취위:0.5%포비잡인5 mg+분태니15μg요마,5 min후경막외급여0.25%포비잡인10 ml;비교각조술중발생저혈압、심률실상、악심、구토、한전적발생솔이급마황소적용약량차이;비교각조마취감각최고조체평면、Bromage평분、복기송이우등솔이급신생인출생후1 min、5min적Apgar평분화출생즉각적제동맥혈기분석치적차이.결과 CO-CSEA조산부술중저혈압발생솔위16.7%,현저저우CR-SA조(46.7%),CO-CSEA조여CO-SA조(20.0%)화CR·CSEA조(26.7%)상비,저혈압발생솔유강저추세,단무통계학의의;CO-CSEA조산부술중심률실상발생솔위3.3%,현저저우CR-SA조(33.3%)화CO-SA조(23.3%),단여CR.CSEA조(10.0%)비교무통계학의의;CO-CSEA조여CR-SA조상비,산부술중마황소용약량현저감소;CO-CSEA조화CO-SA조악심、구토적발생솔현저저우CR-SA조;각조한전반응발생솔도교저,무통계학차이;각조병인마취감각조체평면、Bromage평분、복기송이우등솔균무통계학차이,신생인Apgar평분화제동맥혈기분석치야균재정상범위,무통계학차이.결론 예부하수주효체액여소제량요경연합마취방법연합응용,가유효증강산부술중심혈관계통적은정성,강저저혈압화심률실상적발생솔,병가감소술중악심、구토등부작용적발생.
Objective To investigate whether combination of preload infusion and low-dose spinal-epidural anesthesia may reduce the incidence of cardiovascular complications for parturients undergoing caesarean section. Methods Parturients undergoing e- lective cesarean section were randomly allocated to one of four groups (n = 30) to receive crystalloid preload infusion followed with spi- nal block (Group CR-SA), colloid preload infusion with spinal anesthesia (Group CO-SA), erystalloid preload followed with combi- ning low-dose spinal - epidural block (Group CR-CSEA), or colloid preload infusion with combining low-dose spinal-epidural anesthe- sia ( Group CO-CSEA). Bupivacaine 7.5 nag and fentanyl 15 μg was injected into subarachncid space for spinal anesthesia, and bupi- vacaine 5 rag + fentanyl 15 μg was injected into subarachnoid space followed with epidural injection of 0.25% bupivacaine 10ml for spinal - epidural block. The changes of SBP and HR, and the occurrence of adverse effects were observed. The block effects and the safety of neonate were assessed. Results The incidence of maternal hypotension was 16.7% in Group CO-CSEA that was significantly lower than in Group CR-SA (46.7%). Compared with Group CO-SA (20.0%) and Group CR-CSEA (26.7%), the incidence ofhy- potension in Group CO-CSEA tended decreasing, but no statistical difference. The occurrence of arrhythmia in Group CO-CSEA (3. 3%) was significantly lower than in Groups CR-SA (33.3%) and CO-SA (23.3%), but no significant difference compared with CR- CSEA (10.0%). Ephedrine administration was needed significantly less for Group CO-CSEA patients than that for CR-SA ones. The incidence of nausea and vomiting was significantly lower in Groups CO-CSEA and CO-SA than in Group CR-SA. The frequency of shiv- ering was low in four Groups and there was no significant difference between them. No differences in block effect, fluid infusion volume and neonatal outcome were found among the four groups. Conclusion Colloid preload infusion followed with low-dose spinal-epidural block may maintain the cardiovascular stability and reduce the side-effects in parturients undergoing caesarean section.