不同穿刺方式对剖宫产术腰硬联合麻醉效果 及安全性的影响

Effects of different puncture methods on efficacy and safety of combined spinal and epidural anesthesia for cesarean women

摘要:

目的 分析不同穿刺方式对剖宫产术腰硬联合麻醉效果及安全性的影响。方法 选取2018 年 1 月—2019 年8 月绵阳市人民医院接诊的176 例剖宫产妇作为研究对象，采用随机数字表法分为A 组和B 组， 每组88 例。两组剖宫产妇采取腰硬联合麻醉：A 组采用传统腰硬穿刺针法，B 组采用轨道式穿刺针法。比较 两组穿刺操作情况、麻醉效果及不良反应发生情况。结果 A 组与B 组一次穿刺成功率、一次置管成功率比较， 差异无统计学意义（P >0.05）；B 组腰麻摆平卧位时间和穿刺操作总时间短于A 组（P <0.05）；B 组Bromage 评分达2 或3 分所需时间短于A 组（P <0.05）；B 组穿刺回抽有血和穿刺有异感患者少于A 组（P <0.05）；B 组仰卧位低血压综合征发生率和恶心呕吐发生率低于A 组（P <0.05）。结论 在剖宫产术腰硬联合麻醉中， 轨道式穿刺针法较传统腰硬穿刺针法可更快获得满意的麻醉效果，减少麻醉不良事件发生，值得临床推广。

Abstract:

Objective To analyze the effects of different puncture methods on the efficacy and safety of combined spinal and epidural anesthesia for cesarean women. Methods A total of 176 cesarean women, who were admitted to our hospital from January 2018 to August 2019, were selected as the research objects, and they were divided into group A and group B with 88 patients for each group by random number table method. All patients were treated with combined spinal and epidural anesthesia. In the choice of puncture method, group A used the traditional spinal and hard puncture needle method, and group B used the orbital puncture needle method. The puncture operation, anesthesia effect and adverse reactions were compared between the two groups. Results There is no significant difference in the success rate of the first puncture and the first catheter placement between group A and group B (P > 0.05); the supine time of spinal anesthesia and total puncture time in group B are shorter than those in group A (P < 0.05 ); the time required for the Bromage score of Group B to reach 2 or 3 scores was shorter than that of Group A (P < 0.05); the blood withdrawal rate and the paraesthesia rate in group B were lower than those in group A (P < 0.05); the incidence of supine hypotension syndrome, nausea and vomiting in group B were lower than those in group A (P < 0.05). Conclusions In combined spinal and epidural anesthesia for cesarean section, the orbital puncture needle method can faster obtain satisfactory anesthesia effect and reduce the occurrence of anesthesia than the spinal and rigid puncture needle method, which is worthy of clinical application.