Effects of the lateral puncture direction of lumbar anesthesia combined spinal epidural anesthesia during cesarean section of pregnant women with pregnancy-induced hypertension on their stress and cognitive function
Objective:To explore the effects of the lateral puncture direction of lumbar anesthesia combined spinal epi-dural anesthesia(CSEA)during cesarean section of pregnant women with pregnancy-induced hypertension(PIH)on their stress hormone and cognitive function.Methods:A total of 102 pregnant women with PIH who wanted cesarean section were divided into three groups(34 cases in each group)by the random number table method from January 2021 to June 2022.CSEA was performed in the women with the same clinostatism and puncture gap in the three groups.The lateral hole of lumbar anesthesia needles in group Ⅰ was facing head,which in group Ⅱ were facing tail,and which in group Ⅲ were facing head and then tail.The hemodynamics and stress hormone indexes changes of the women were compared among the three groups.The anesthetic effect and safety of the women in the three groups were evaluated.The cognitive function of the women in the three groups was evaluated by the Mini Mental State Examination(MMSE),and the incidence of cognitive impairment of the women within 72h after cesarean section was calculated.Results:There were no significant differences in the onset time of motor/sensory block,the analgesic effect,the heart rate(HR)and MMSE score at different time points of the women among the three groups(P＞0.05).The area of the highest block level of the women in group Ⅰ was significantly wider than that of the women in group Ⅱ and that of the women in group Ⅲ.The values of diastolic blood pressure and systolic blood pressure of the women in group Ⅰ at 5 min after spinal anesthesia were significantly lower than those of the women in group Ⅱ and those of the women in group Ⅲ(all P＜0.05).There were no significant differences in area of the highest block level and the values of diastolic blood pressure and systolic blood pressure of the women between group Ⅱ and group Ⅲ(P＞0.05).The levels of serum C-peptide,cortisol and advanced oxidation protein products of the women in the three groups at 24 hours after cesarean section had increased significantly,and which of the women in group Ⅰ and group Ⅲ were significantly lower than those of the women in group Ⅱ(P＜0.05),but which of the women had no significantly different between group Ⅰ and groupⅢ(P＞0.05).The MMSE scores of the women in the three groups at 24 hours after cesarean section had decreased significantly,and which of the women had no significantly different among the three groups(P＜0.05).There was no significant difference in the incidence of cognitive impairment of the women within 72 hours after cesarean section a-mong the three groups(P＞0.05).The incidences of nausea and vomiting(20.6％)and hypotension(32.4％)of the women in group Ⅰ were the highest,and the incidence of visceral traction reaction(17.7％)of the women in group Ⅱwas the highest(P＜0.05).Conclusion:The lateral hole administration of CSEA first toward the head and then toward the tail during cesarean section of the pregnant women with PIH has better analgesic effect and less adverse reactions,and which has less influence on the stress hormone indexes and cognitive function of the women.
Pregnancy-induced hypertensionCesearean sectionCombined spinal epidural anesthesiaNeedle lateral directionStress hormoneCognitive function
万方数据
维普
