论文部分内容阅读
目的 探讨体位干预对腰硬联合麻醉剖宫产布比卡因阻滞平面的影响.方法 选取择期剖宫产产妇90例,术中采用布比卡因行腰硬联合麻醉,随机分为A组、B组和C组各30例.注药后给予不同体位干预,A组为水平仰卧位,B组为头低足高5.,C组为头低足高10°,麻醉成功后均恢复水平仰卧位.比较3组穿刺后脑脊液流出时间、感觉阻滞起效时间、运动阻滞起效时间、阻滞完善时间、最高麻醉平面及麻醉效果.记录注药后不同时间点5、10、15、20 min产妇血流动力学指标,包括舒张压(DBP)、收缩压(SBP)和心率(HR),观察产妇麻醉相关不良反应.结果 3组产妇脑脊液流出时间差异有统计学意义(P＜0.05),由长到短依次为C组、B组和A组.3组产妇感觉阻滞起效时间、运动阻滞起效时间和阻滞完善时间差异均无统计学意义(P＞0.05).3组产妇最高麻醉平面差异有统计学意义(P＜0.05),由高到低依次为C组、B组和A组.B组和C组麻醉效果均高于A组,差异均有统计学意义(P＜0.05).C组不良反应发生率高于A、B两组(P＜0.05).C组注药后不同时间点DBP、SBP和HR的波动幅度高于A、B两组,注药后10和15 min C组DBP和SBP低于A、B两组,HR高于A、B两组,差异均有统计学意义(P＜0.05).结论 对于布比卡因腰硬联合麻醉的剖宫产产妇,注药前采取头低足高5.体位可在控制麻醉平面的基础上获得较好麻醉效果,产妇血流动力学稳定.“,”Objective To explore the effect of posture intervention on block level of bupivacaine in combined spinal and epidural analgesia for cesarean sectiou.Methods Ninety women undergoing selective cesarean section were selected,all the women were treated by combined spinal and epidural analgesia using bupivacaine,then they were randomly divided into group A,group B,and group C,30 cases in each group.The cases in the three groups were treated with different position intervention measures:horizontal supine position (group A),lower-head and higher-feet position (5°) (group B),and lower-head and higher-feet position (10°) (group C).After successful anesthesia,all the cases adopted horizontal supine position.The time of cerebrospinal fluid outflow after puncture,onset time of sensory blockade,onset time of motor blockade,finished time of blockade,the highest block level,and anesthetic effect in the three groups were compared.The hemodynamic indexes at 5,10,15,and 20 minutes after anesthesia in the three groups were recorded,including diastolic blood pressure (DBP),systolic blood pressure (SBP),and heart rate (HR).The relevant adverse reactions of anesthesia in the three groups were observed.Results There was statistically significant difference in the time of cerebrospinal fluid outflow among the three groups (P＜0.05),group C＞group B＞group A.There was no statistically significant difference in onset time of sensory blockade,onset time of motor blockade,and finished time of blockade among the three groups (P＞0.05).There was statistically significant difference in the highest block level among the three groups (P＜0.05),group C＞group B＞group A.The anesthetic effects in group B and group C were statistically significantly better than that in group A (P＜0.05).The incidence rate of adverse reactions in group C was statistically significantly higher than those in group A and group B (P＜0.05).The amplitudes of fluctuation of DBP,SBP,and HR at different time points after anesthesia in group C were higher than those in group A and group B,the levels of DBP and SBP at 10 and 15 minutes after anesthesia in group C were lower than those in group A and group B,the levels of HR at 10 and 15 minutes after anesthesia in group C were higher than those in group A and group B,there were statistically significant differences (P＜0.05).Conclusion Lower-head and higher-feet position (5 °) can obtain a good anesthetic effect based on controlling block level of bupivacaine in combined spinal and epidural analgesia for cesarean section,and the hemodynamic indexes are stable.