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目的;探讨硬膜外麻醉、蛛网膜下腔-硬膜外麻、气管插管全麻三种不同麻醉方式对剖宫产产妇血流动力学及胎儿的影响。方法:纳入行择期剖宫产产妇152例,采用随机表法将其分为硬膜外组(48例)、腰硬联合麻醉组(52例)、气管内插管全麻组(52例)。观察麻醉前正常状态时(T1)、麻醉成功后5 min(T2)、胎儿娩出时(T3)三个时间点产妇SBP、DBP、HR、SV、CO、SVR及胎儿相关指标,包括出生后1 min、5 min Apgar评分、脐动脉血pH、PCO_2、PO_2。结果:硬膜外麻、腰麻-硬膜外联合麻醉、全麻三组间麻醉起效时间有明显统计学差异(P<0.05),气管内插管全麻组起效时间最快。三组间在T1时间点SBP、DBP、HR、SV、CO、SVR差异无统计学意义(P>0.05)。在T2时间点,硬膜外麻、联合麻醉、全麻三组SBP、DBP、HR、SVR水平均较T1时间点明显降低,差异有统计学意义(P<0.05)。T2时间点,全麻组SBP、DBP、HR、SVR水平高于硬膜外、联合麻醉组(P<0.05)。T3时间点三组SBP、DBP、HR、SV、CO水平均较T2时间相比差异有统计学意义(P<0.05)。T3时间点,全麻组SBP、DBP、SVR高于其他两组,心率低于其他两组,差异有统计学意义(P<0.05)。三组间新生儿出生后1 min Apagr、5 min Apgar评分、脐动脉血学pH、PCO_2无统计学差异(P>0.05)。三组间脐动脉血PO_2有明显统计学差异(P<0.05),气管内插管全麻组脐动脉血PO_2最高。结论:三种麻醉均可以用于剖宫产术,全麻剖宫产术对产妇血流动力学影响最小,起效快,但对胎儿脐动脉血氧浓度有一定的影响。
Objective To investigate the effects of epidural anesthesia, subarachnoid-epidural anesthesia and general anesthesia with tracheal intubation on hemodynamics and fetus in cesarean section. Methods: Fifty-two women with elective cesarean section were included in this study. They were divided into epidural group (48 cases), combined spinal-epidural anesthesia group (52 cases) and endotracheal intubation group (52 cases) . The SBP, DBP, HR, SV, CO, SVR and fetus related indicators such as prenatal 1 (T1), 5 min after anesthesia success (T2) and fetus delivery (T3) min, Apgar score at 5 min, umbilical arterial pH, PCO_2, PO_2. Results: The anesthetic onset time of epidural anesthesia, spinal anesthesia - epidural anesthesia and general anesthesia was significantly different (P <0.05). The anesthesia of endotracheal intubation group had the fastest onset of anesthesia. There were no significant differences in SBP, DBP, HR, SV, CO and SVR between the three groups at T1 time point (P> 0.05). At T2, SBP, DBP, HR and SVR in epidural anesthesia, anesthesia and anesthesia groups were significantly lower than those at T1 time points (P <0.05). At T2, the levels of SBP, DBP, HR and SVR in general anesthesia group were higher than those in epidural and combined anesthesia group (P <0.05). There were significant differences in SBP, DBP, HR, SV and CO levels between the three groups at T3 time point as compared with those at T2 time point (P <0.05). At T3, SBP, DBP and SVR in general anesthesia group were higher than those in the other two groups, with a lower heart rate than the other two groups (P <0.05). Apgar, 1 min Apgar score, umbilical arterial pH and PCO 2 at 1 min after birth were not significantly different between the three groups (P> 0.05). There were significant differences in PO_2 in umbilical arterial blood among the three groups (P <0.05), and PO_2 in umbilical arterial blood in anesthesia group was the highest. CONCLUSION: All three kinds of anesthesia can be used for cesarean section. Cinearectomy has the least effect on the hemodynamics and has a rapid onset of effect. However, it has a certain effect on fetal umbilical arterial oxygen concentration.