CAJ | 학술논문

目的观察不同体位穿刺腰硬联合麻醉( CSEA)在肥胖产妇剖宫产手术中对产妇麻醉效果、麻醉操作和血流动力学的影响。方法选择剖宫产手术肥胖产妇80例[体重指数( BMI )≥30]， ASA 分级玉或域级，随机均分为两组， A组：侧卧位腰硬联合麻醉，腰麻液为0.5%盐酸罗哌卡因2.4 ml。 B组：坐位腰硬联合麻醉，腰麻液同A组。记录两组一次穿刺成功率、麻醉平面、麻醉效果、血流动力学变化及不良反应发生情况(包括术中仰卧位低血压综合征，脊麻后头痛以及术后脊神经刺激)。结果 B组麻醉效果与A组相比差异无统计学意义，但一次穿刺成功率高于A组(P<0.05)，血流动力学变化差异有统计学意义( P<0.05)。仰卧位低血压综合征的发生率低于A组( P<0.05)。结论两种体位腰硬联合麻醉在肥胖产妇剖宫产手术麻醉中具有相同的麻醉效果，但坐位腰硬联合麻醉比侧卧位更易于穿刺操作，血流动力学更稳定。
목적관찰불동체위천자요경연합마취( CSEA)재비반산부부궁산수술중대산부마취효과、마취조작화혈류동역학적영향。방법선택부궁산수술비반산부80례[체중지수( BMI )≥30]， ASA 분급옥혹역급，수궤균분위량조， A조：측와위요경연합마취，요마액위0.5%염산라고잡인2.4 ml。 B조：좌위요경연합마취，요마액동A조。기록량조일차천자성공솔、마취평면、마취효과、혈류동역학변화급불량반응발생정황(포괄술중앙와위저혈압종합정，척마후두통이급술후척신경자격)。결과 B조마취효과여A조상비차이무통계학의의，단일차천자성공솔고우A조(P<0.05)，혈류동역학변화차이유통계학의의( P<0.05)。앙와위저혈압종합정적발생솔저우A조( P<0.05)。결론량충체위요경연합마취재비반산부부궁산수술마취중구유상동적마취효과，단좌위요경연합마취비측와위경역우천자조작，혈류동역학경은정。
Objective To observe the influence of combined spinal and epidural anesthesia( CSEA) of different po-sitions on the anesthesia effect, anesthesia operation and hemodynamic index during cesarean section of obese par-turients. Methods Eighty obese parturients[BMI≥30] undergoing cesarean section were randomly divided into two groups, that was group A and B, with 40 cases each. In group A, the parturients were required to undergo lat-eral decubitus position with 0.5% ropivacaine hydrochloride of 2. 4 ml. In group B, the parturients were required to undergo sitting position with the same ropivacaine hydrochloride as group A. The following data was recorded, which were the percentage of one-attempt's successful epidural needle placement, the anesthesia level,the anesthe-sia effect and the hemodynamic change. All the complications were also observed,such as the supine hypotension syndrome during operation,headache after spinal anesthesia and postoperative spinal nerve stimulation. ResultsThe difference of anesthetic effect between the two groups was insignificant in statistics while group B's rate of one-attempt successful puncture was higher than gruop A ( P <0.05 ) . The difference of hemodynamic index between them was significant in statistics ( P<0.05 ) with group B's rate of supine hypotension syndrome lower than group A. Conclusion Both body positions have the same anesthtic effect for obese parturients during cesarean section while the puncture operation of sitting positon is easier than lateral decubitus position and the hemodynamic change is also more stable.