三种麻醉方式在剖宫产术中的效果比较及对胎儿的影响(1)
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[摘要] 目的 比较单纯硬膜外麻醉、腰麻-硬膜外联合麻醉和全身麻醉在剖宫产术的麻醉效果及对胎儿的影响。 方法 将本院行剖宫产的210例孕妇分为E组(单纯硬膜外麻醉)、C组(腰麻-硬膜外联合麻醉)和I组(静脉麻醉)，比较三组麻醉起效时间、麻醉阻滞效果、新生儿Apgar评分和NBNA评分以及不良反应。 结果 三组麻醉起效时间从慢到快依次为E组、C组和I组，差异有统计学意义(P < 0.05)；E组Bromage评分显著低于C组与I组(P < 0.05)，C组与I组比较差异无统计学意义(P > 0.05)；三组新生儿Apgar评分、NBNA评分和不良反应发生率比较，差异无统计学意义(P > 0.05)。 结论 腰麻-硬膜外联合麻醉起效时间短，麻醉效果佳，是剖宫产的理想麻醉方法，三组麻醉方法对新生儿均无不良影响。
[关键词] 剖宫产；麻醉方式；新儿
[中图分类号] R713.4 [文献标识码] A [文章编号] 1673-7210(2012)04(a)-0103-02
Effect comparison of three anesthesia methods in caesarean section and its influence on infants
LIU Bihua PU Jiangbei
Department of Anesthesiology, the First Traditional Chinese Medical Hospital of Jiulongpo District in Chongqing City, Chongqing 400080, China
[Abstract] Objective To compare the effect of epidural anesthesia, combined spinal-epidural anesthesia and general anesthesia in caesarean section and its influence on infants. Methods 210 pregnant women were divided into group E (epidural anesthesia), group C (combined spinal-epidural anesthesia) and group I (general anesthesia) with 70 patients in each group. The onset time of anaesthesia, Apgar and NBNA scores of newborn and adverse reaction were compared between three groups. Results The onset time of anaesthesia in group E was much slower than that in group C and group I (P < 0.05); Bromage scores in group E were lower than group C and I (P < 0.05), but there was no significant difference in group C and I (P > 0.05); Apgar and NBNA scores of newborn and adverse reaction were no statistical difference among three groups (P > 0.05). Conclusion Combined spinal-epidural anesthesia is an ideal anesthesia method in caesarean with short onset time and a good effect. Three methods all have no influence for newborn.
[Key words] Caesarean section; Anesthesia method; Newborn
近年来随着医学技术的发展及社会因素的原因剖宫产分娩比例在逐渐增加[1]，剖宫产的麻醉要求诱导期短、效果确切及肌松良好，同时对胎儿安全，影响小[2]。单纯硬膜外麻醉及腰麻-硬膜外联合麻醉是剖宫产手术常用的麻醉方式，但是对于一些高危或不适用上述两种麻醉方式的孕妇，则应选择全身麻醉。为探讨三种麻醉方式在剖宫产术的麻醉效果及对胎儿的影响，笔者对210例孕产妇分析如下：
1 资料与方法
1.1 一般资料
对2008年2月~2010年2月于本院分院分娩的210例孕产妇资料进行回顾性分析，ASAⅠ~Ⅱ级；年龄24~39岁，中位数年龄27 ......
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