CAJ | 학술논문

目的比较腰麻-硬膜外联合麻醉和硬膜外麻醉在瘢痕子宫剖宫产术中的麻醉效果和安全性.方法 120例瘢痕子宫患者行剖宫产术,年龄23～ 42岁,平均(32±11)岁,按抽签法随机分为连续硬膜外麻醉(EA)组60例和腰麻-硬膜外联合麻醉(CSEA)组60例.监测心电图、血压、心率、呼吸频率和动脉血氧饱和度,用针刺法测定两组的痛觉消失平面(麻醉平面),记录感觉阻滞起效时间(指给药后感觉阻滞部位发热、麻木等的时间),用改良的Browage分级法评定下肢运动阻滞效果,评定麻醉效果,新生儿的Apgar评分,术后随访麻醉后头痛、呕吐等不良反应.结果 EA组感觉阻滞起效时间明显慢于CSEA组,麻醉平面明显低于CSEA组,下肢运动阻滞效果小于CSEA组,差异有统计学意义(P＜0.01或＜0.05).EA组中7例术中由于麻醉阻滞不全、有较强痛感而不能耐受者加局部麻醉浸润或辅助静脉镇痛药完成手术,2例术中由于无法耐受手术而改气管插管全身麻醉；CSEA组中无一例辅助静脉镇痛药和改全身麻醉,CSEA组麻醉效果明显优于EA组(P＜0.01).CSEA组术后无一例腰麻后头痛和神经系统并发症发生.胎儿娩出时及出生后1 min Apgar评分CSEA组明显高于EA组(P＜0.05),出生后5、10 min Apgar评分两组比较差异无统计学意义(P＞0.05).结论只要严格控制注药的速度和麻醉平面,采用小剂量麻醉药,CSEA应用于瘢痕子宫剖宫产术是安全的,麻醉效果是确切的,可缩短胎儿娩出时间,提高新生儿Apgar评分,与EA比较有很大的优越性,可作为瘢痕子宫剖宫产术的首选麻醉方法.
목적 비교요마-경막외연합마취화경막외마취재반흔자궁부궁산술중적마취효과화안전성.방법 120례반흔자궁환자행부궁산술,년령23～ 42세,평균(32±11)세,안추첨법수궤분위련속경막외마취(EA)조60례화요마-경막외연합마취(CSEA)조60례.감측심전도、혈압、심솔、호흡빈솔화동맥혈양포화도,용침자법측정량조적통각소실평면(마취평면),기록감각조체기효시간(지급약후감각조체부위발열、마목등적시간),용개량적Browage분급법평정하지운동조체효과,평정마취효과,신생인적Apgar평분,술후수방마취후두통、구토등불량반응.결과 EA조감각조체기효시간명현만우CSEA조,마취평면명현저우CSEA조,하지운동조체효과소우CSEA조,차이유통계학의의(P＜0.01혹＜0.05).EA조중7례술중유우마취조체불전、유교강통감이불능내수자가국부마취침윤혹보조정맥진통약완성수술,2례술중유우무법내수수술이개기관삽관전신마취；CSEA조중무일례보조정맥진통약화개전신마취,CSEA조마취효과명현우우EA조(P＜0.01).CSEA조술후무일례요마후두통화신경계통병발증발생.태인면출시급출생후1 min Apgar평분CSEA조명현고우EA조(P＜0.05),출생후5、10 min Apgar평분량조비교차이무통계학의의(P＞0.05).결론 지요엄격공제주약적속도화마취평면,채용소제량마취약,CSEA응용우반흔자궁부궁산술시안전적,마취효과시학절적,가축단태인면출시간,제고신생인Apgar평분,여EA비교유흔대적우월성,가작위반흔자궁부궁산술적수선마취방법.
Objective To compare the anesthetic effect and safety of combined spinal epidural anesthesia (CSEA) and epidural anesthesia (EA) in the scarred uterus during cesarean section.Methods One hundred and twenty cases of the scar uterine pregnant woman aged 23-42,were randomly divided into two groups,EA group (60 cases)and CSEA group(60 cases).In each group,patient were given EA or CSEA before cesarean section,and the ECG,BP,HR,RR and SpO2 were monitored.The pain disappear plane by acupuncture was determined,and the sensory block onset time (when the sensory block parts have fever or numbness after the drug delivery time) was recorded.The lower limb motor block effects were indentified by the improved Browage grading,the Apgar scores of the newborns were recorded and the adverse reactions such as headache,vomiting after anesthesia were observed.Results The sensory block onset time of EA group was significantly slower than that of CSEA group (P ＜ 0.05),the pain disappear plane of CSEA group was higher than that of EA group (P ＜ 0.05),the limb motor block effect of EA group was much lower than that of CSEA group (P ＜ 0.01).Because of insufficient anesthesia,7 cases in EA group could not tolerate the surgery,and had to add assisted local infiltration anesthesia or intravenous analgesics to complete the operation,2 of them changed to general anesthesia.None of the patients in CSEA group had assisted intravenous analgesics or changed to general anesthesia,the anesthetic effect was significantly better than EA group (P ＜0.01).There were no cases of headache or neurological complications occurred in CSEA group after anesthesia.The Apgar scores of the newborns when the baby was delivered and 1 min after birth in CSEA group were significantly better than those in EA group (P ＜ 0.05),and there was no significant difference in the Apgar scores 5 min or 10 min after birth between the two groups (P ＞ 0.05).Conclusions By small doses of anesthetics,strictly controling the speed of injection and anesthesia plane,CSEA has a great superiority compare to EA when apply to the scarred uterus during cesarean section,CSEA is safe and effective,and can be used as the first choice for anesthesia in the scarred uterus during cesarean section operation.