摘要
目的 比较腰硬联合麻醉与硬膜外麻醉对高龄产妇剖宫产术后认知障碍和应激反应的情况.方法 选取110 例高龄剖宫产产妇作为研究对象,随机将其分为腰硬联合麻醉组(观察组,n=55)和硬膜外麻醉组(对照组,n=55).比较两组麻醉效果、术后认知障碍、应激水平、血流动力学及不良反应.结果 观察组麻醉效果优于对照组,差异有统计学意义(Z=5.67,P＜0.05).在切皮即刻(T2)、缝皮结束即刻(T3)时点,观察组患者的平均动脉压、心率和血氧饱和度水平均高于对照组,差异均有统计学意义(t分别=3.06、2.69、2.67、4.10、11.32、6.63,P均＜0.05).术后6h及24 h,观察组患者的肾上腺素(EP)、去甲肾上腺素(NE)、皮质醇(Cor)水平均低于对照组,差异均有统计学意义(t分别=-3.26、-4.53、-2.16、-2.44、-2.34、-3.43,P均＜0.05);术后6h及24 h,观察组患者的简易精神状态评价量表(MMSE)评分均高于对照组,差异均有统计学意义(t分别=3.36、3.81,P均＜0.05).两组总不良反应发生率比较,差异无统计学意义(χ2=0.23,P＞0.05).结论 腰硬联合麻醉效果较佳,且安全性好,可减轻高龄剖宫产产妇血流动力学波动幅度,降低其机体应激反应,减轻对其认知功能的损伤.
Abstract
Objective To compare the effects of lumbar epidural anesthesia and epidural anesthesia on cognitive im-pairment and stress response in elderly parturients undergoing cesarean section.Methods A total of 110 elderly parturi-ents undergoing cesarean section were selected as the study subjects,and randomly divided into lumbar epidural anesthe-sia group(observation group,n=55)and epidural anesthesia group(control group,n=55).The anesthesia effects,postop-erative cognitive impairment,stress levels,hemodynamics,and adverse reactions of the two groups were compared.Re-sults The anesthesia effect of the observation group was better than that of the control group,and the difference was sta-tistically significant(Z=5.67,P＜0.05).At the moment of skin cutting(T2)and the end of skin suture(T3),the average arterial pressure,heart rate,and blood oxygen saturation levels of the observation group patients were higher than those of the control group,and the differences were statistically significant(t=3.06,2.69,2.67,4.10,11.32,6.63,P＜0.05).At 6 hours and 24 hours after surgery,the levels of epinephrine(EP),norepinephrine(NE),and cortisol(Cor)in the obser-vation group were lower than those in the control group,and the differences were statistically significant(t=-3.26,-4.53,-2.16,-2.44,-2.34,-3.43,P＜0.05).At 6 hours and 24 hours after surgery,the mini mental state examination scale(MMSE)scores of the observation group were higher than those of the control group,and the differences were statistical-ly significant(t=3.36,3.81,P＜0.05).There was no statistically significant difference in the overall incidence of adverse reactions between the two groups(χ2=0.23,P＞0.05).Conclusion The combined spinal and epidural anesthesia has a better effect and good safety,which can reduce the hemodynamic fluctuations of elderly cesarean section women,reduce their stress response,and alleviate the damage to their cognitive function.
维普
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