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目的:探讨腰硬膜外联合麻醉和持续硬膜外麻醉在二次剖宫产手术中的临床价值。方法:收集重庆市渝北区妇幼保健院于2014年12月至2015年11月诊治的二次剖宫产手术孕妇中抽取91例,按照随机数字法原则分成观察组(n=46)、对照组(n=45)。观察组采取腰硬膜外联合麻醉,对照组采取持续硬膜外麻醉,分析两组孕妇的麻醉效果以及血流动力学变化。结果:观察组麻醉起效时间(5.2±1.1)min和麻醉诱导至切皮时间(11.2±3.4)min均较对照组短(P<0.05),麻醉药用量(15.0±0.0)mg小于对照组(78.4±12.6)mg(P<0.05),运动神经阻滞评分和麻醉后10 min的舒张压(DBP)、收缩压(SBP)和心率(HR)也明显低于对照组(P<0.05);观察组不良反应发生率是8.7%,远低于对照组的24.4%(P<0.05)。结论:相较于持续硬膜外麻醉,腰硬膜外联合麻醉在二次剖宫产手术中的麻醉效果显著且安全性较高。
Objective: To investigate the clinical value of combined epidural anesthesia and continuous epidural anesthesia in secondary cesarean section. Methods: Ninety-one pregnant women with secondary cesarean section who were diagnosed and treated in Yubei District Maternal and Child Health Hospital from December 2014 to November 2015 were divided into observation group (n = 46) according to random number principle and control group Group (n = 45). The observation group was treated with combined epidural anesthesia, the control group with continuous epidural anesthesia, anesthesia and hemodynamic changes in both groups were analyzed. Results: The onset time of anesthesia (5.2 ± 1.1) min and the induction of skin incision (11.2 ± 3.4) min in the observation group were shorter than those in the control group (P <0.05) (P <0.05). Motor nerve block score and diastolic blood pressure (DBP), systolic blood pressure (SBP) and heart rate (HR) at 10 min after anesthesia were also significantly lower than those in the control group (P <0.05) ). The adverse reaction rate in the observation group was 8.7%, much lower than that in the control group (24.4%, P <0.05). CONCLUSIONS: Compared with continuous epidural anesthesia, epidural anesthesia has a significant and safe anesthetic effect in secondary cesarean section.