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目的:探讨HIV感染者剖宫产术的麻醉方法。方法:HIV感染者足月妊娠62例随机分为A组:单纯硬膜外麻醉组(EA组)和B组:腰硬联合麻醉组(CSEA组),每组31例。观察麻醉显效时间、镇痛肌松效果,麻醉显效前、显效后、胎儿娩出后5min的血压,新生儿娩出后1、5min Apgar评分,麻醉优良率及T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+比值并统计。结果:CSEA组麻醉起效快于EA组,差异有统计学意义(P<0.01),CSEA组显效时间快、麻醉完善、镇痛和肌松效果明显优于EA组。CSEA组的麻醉效果优良率与EA组差异有统计学意义(P<0.05)。CSEA组低血压的发生率高于EA组,但差异无统计学意义(P>0.05)。两组新生儿1、5minApgar评分均大于8分,差异无统计学意义。术前术后外周血测定T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+比值,差异无统计学意义(P>0.05)。结论:两种麻醉方法在HIV感染者剖宫产术的麻醉都可行,但腰麻-硬膜外联合麻醉比单纯硬膜外麻醉具有更大优越性。
Objective: To investigate the anesthetic method of cesarean section in HIV-infected patients. Methods: Totally 62 pregnant women with term HIV infection were randomly divided into group A: EA group and group B: CSEA group with 31 cases in each group. The anesthetic effect, analgesia and muscle relaxant effect, anesthesia before and after markedly effective, blood pressure 5 minutes after delivery, neonatal 1,5min Apgar score, excellent anesthesia rate and T lymphocyte subsets CD3 +, CD4 +, CD8 + CD4 + / CD8 + ratio and statistics. Results: The onset of anesthesia in CSEA group was faster than that in EA group. The difference was statistically significant (P <0.01). CSEA group had faster onset of anesthesia, better anesthesia, and better analgesia and muscle relaxant effect than EA group. The excellent rate of anesthesia in CSEA group was significantly different from EA group (P <0.05). The incidence of hypotension in CSEA group was higher than that in EA group, but the difference was not statistically significant (P> 0.05). 1,5minApgar score of neonates in both groups were greater than 8 points, the difference was not statistically significant. Preoperative and postoperative peripheral blood T lymphocyte subsets CD3 +, CD4 +, CD8 +, CD4 + / CD8 + ratio, the difference was not statistically significant (P> 0.05). CONCLUSION: Both anesthesia methods are feasible for cesarean delivery in HIV-infected patients. However, spinal-epidural anesthesia has more advantages than simple epidural anesthesia.