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佘锐璇.硬膜外阻滞与蛛网膜下阻滞行剖宫产对新生儿脐带血血气的影响[J].中国现代医生,2021,59(14):131-134
硬膜外阻滞与蛛网膜下阻滞行剖宫产对新生儿脐带血血气的影响
The effect of epidural block and subarachnoid block for cesarean section on umbilical cord blood gas of newborn
  
DOI:
中文关键词:  硬膜外阻滞  蛛网膜下阻滞  剖宫产  新生儿  血气分析
英文关键词:Epidural block  Subarachnoid block  Cesarean section  Newborn  Blood gas analysis
基金项目:广东省佛山市卫生健康局医学科研课题(20200216)
作者单位
佘锐璇 广东省佛山市妇幼保健院麻醉科广东佛山 528000 
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中文摘要:
      目的 探讨硬膜外阻滞与蛛网膜下阻滞行剖宫产对新生儿脐带血血气分析的影响。方法 将2020 年3 至10 月本院分娩的200 例剖宫产产妇随机分为对照组(n=100)和研究组(n=100),对照组分娩镇痛采用连续硬膜外阻滞,研究组采用蛛网膜下腔阻滞,比较两组麻醉镇痛相关指标及麻醉相关并发症、新生儿出生后脐带血血气分析指标及各时段Apgar 评分。结果 研究组感觉阻滞平面恢复正常时间、达最大感觉阻滞平面时间皆短于对照组(P<0.05),两组术后最大视觉模拟评分法(VAS)评分及所需药物止痛时间比较,差异无统计学意义(P>0.05);研究组镇痛10 min、30 min、60 min 时的平均动脉压(MAP)低于对照组(P<0.05),两组镇痛即刻的MAP 比较,差异无统计学意义(P>0.05);两组的恶心呕吐、低血压、心动过缓、寒颤等麻醉相关并发症发生率的比较,差异无统计学意义(P>0.05);两组新生儿出生后脐带血pH 值、二氧化碳分压(PaCO2)、氧分压(PaO2)、剩余碱(BE)等血气分析相关指标与1、5、10 min 等各时段Apgar 评分比较,差异无统计学意义(P>0.05)。结论 蛛网膜下腔阻滞用药量较之硬膜外阻滞更小,综合麻醉效果优于后者,对胎儿及产妇所产生的影响更小,且不会增加麻醉相关并发症,值得临床推广。
英文摘要:
      Objective To investigate the influence of epidural block and subarachnoid block for cesarean section on neonatal umbilical cord blood gas analysis.Methods 200 cases of cesarean section women who gave birth in our hospital from March to October 2020 were randomly divided into the control group (n=100) and the study group (n=100).The control group was given continuous epidural analgesia for labor analgesia.The study group was given subarachnoid block.The related indexes of anesthesia and analgesia,anesthesia-related complications,the umbilical cord blood gas analysis index of newborns after birth,and Apgar scores in each period between two groups were compared.Results The time for the sensory block level to return to normal and the time to reach the maximum sensory block level in the study group were shorter than those in the control group (P<0.05).The difference in the maximum visual analogue scale(VAS) score and the time required to relieve pain between the two groups was not statistically significant (P>0.05).The mean arterial pressure (MAP) of the study group at 10,30,and 60 minutes of analgesia was lower than that of the control group (P<0.05).There was no statistically significant difference in the MAP of immediate analgesia between the two groups (P>0.05).There was no significant difference in the incidence of nausea and vomiting,hypotension,bradycardia,chills and other anesthesia-related complications between the two groups (P>0.05).There was no statistical difference(P>0.05) in the cord blood gas analysis indexes after birth,including pH,partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen (PaO2),residual alkali (BE),and Apgar scores at 1,5,and 10 minutes between the two groups of newborns.Conclusion Compared with epidural block,the subarachnoid block has a smaller drug dosage,better comprehensive anesthesia effect,and less impact on the fetus and the puerpera.It will not increase the anesthesia-related complications and is worthy of clinical promotion.
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