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腰麻与硬膜外麻醉对剖宫产母婴安全及应激反应的影响 |
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赵新生 李树人 屈劲风 商富民 费洪亮
摘要 目的：研究椎管内麻醉对剖宫产母婴安全和应激反应。方法：选择ASAⅠ级剖宫产42例，随机分腰麻组和硬膜外组各21例。腰麻组用重比重0.5%丁哌卡因3ml，硬膜外组用0.75%丁哌卡因12～15ml。两组产妇于入手术室、麻醉后、胎儿娩出、手术结束，新生儿脐静脉抽取血样，检测儿茶酚胺、血糖、乳酸、血气。结果：两组儿茶酚胺麻醉后不同期间均比麻醉前明显降低(P＜0.01)，两组产妇血糖、乳酸不同期间均无显著性差异，两组新生儿Apgar评分无显著性差异。结论：腰麻与硬膜外麻醉均可抑制产妇手术的应激反应，有利于产妇术后恢复，对新生儿无不良抑制，运用得当可保证母婴安全。
关键词 椎管内麻醉 剖宫产 母亲 婴儿，新生 安全 应激反应
Materal-neonatal safety and stress during spinal and epidural anesthesia for cesarean section Zhao Xinsheng，Li Shuren，Qu Jinfeng，et al．Department of Anesthesiology，Yanhua Hospital，Beijing 102500
Abstract Objective：The materal-neonatal safety and materal stress response were evaluated during intrathecal anesthesia. Method：Forty-two parturients（ASA grade Ⅰ)were randomly divided into two groups：spinal group (n=21),epidural group (n=21).3 ml of 0.5% hyperbaric bupivacaine was given in spinal group；12-15ml of 0.75% bupivacaine was administrated in epidural group．Materal arterial samples were drawn before anesthesia，after anesthesia induction， after delivery and at the end of surgery ；umbilical venous samples were taken for measurements of blood catecholamine，sugar and lactate concentrations．Result：Compared with those before intrathecal blockade， plasma levels of catecholamine of two groups were significantly decreased in different periods during anesthesia (P＜0.01)；levels of materal blood sugar and lactate in both groups remained unchanged during whole procedures(P＞0.05)； there were not any significant differences between the two groups in neonate Apgar scores． Conclusion：Both of two techniques can inhibit stress response of parturients to cesarean sections and have no adverse effects to neonates when applied in proper management．
Key words Cesarean section Mothers Infant，newborn Safety Stress Anesthesia，epidural Anesthesia，spinal
通过观察腰麻与硬膜外阻滞效果、血流动力学指标变化、麻醉并发症、新生儿Apgar评分和儿茶酚胺、血糖、乳酸、血气，对剖宫产两种麻醉方法和母婴安全及应激反应程度进行对比分析，探讨两种麻醉对剖宫产母婴影响。
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