目的 探讨脉冲泵椎管内分娩镇痛失败中转剖宫产的麻醉方式.方法 120例脉冲泵椎管内分娩镇痛失败中转剖宫产产妇为研究对象,按随机数字表法分为A、B、C三组,各 40 例.A组实施腰硬联合麻醉,B组使用分娩镇痛留置的导管行硬膜外麻醉,C组实施气管插管全身麻醉(全麻).比较三组围麻醉期并发症发生率,入室至切皮时间及麻醉至胎儿取出时间,新生儿出生时、出生 1 min和出生5 min Apgar评分.结果 C组围麻醉期高血压、低血压、恶心呕吐发生率显著低于A组和B组(P<0.05);三组围麻醉期误吸发生率比较差异无统计学意义(P>0.05).C组入室至切皮时间和麻醉至胎儿取出时间分别为(8.2±1.6)、(5.3±0.7)min,均短于A组的(15.7±2.6)、(12.2±2.5)min和B组的(15.6±2.7)、(11.5±2.3)min(P<0.05).C组新生儿出生时、出生 1 min和出生 5 min Apgar评分分别为(7.8±1.4)、(8.6±0.4)、(9.1±0.7)分,均显著高于A组的(7.0±0.7)、(7.4±0.6)、(8.0±0.5)分和B组的(7.1±0.8)、(7.5±0.6)、(8.1±0.5)分(P<0.05).结论 气管插管全麻用于脉冲泵椎管内分娩镇痛分娩失败中转剖宫产者,具有并发症少,快速娩出胎儿,减少新生儿窒息风险等优势.
Selection of the best anesthesia mode for cesarean section after failure of intraspinal delivery analgesia with pulse pump
Objective To explore the anesthesia mode for cesarean section after failure of intraspinal delivery analgesia with pulse pump.Methods 120 patients undergoing cesarean section after failure of intraspinal delivery analgesia with pulse pump were selected as the research subjects.According to the random number table,they were divided into groups A,B and C,with 40 cases in each group.Group A was given combined spinal-epidural anesthesia,group B was given epidural anesthesia with indwelling catheter for labor analgesia,and group C was given general anesthesia with tracheal intubation.The incidence of perianesthetic complications,time from entering the room to cutting skin,time from anesthesia to taking out the fetus,and Apgar score at birth,1 min after birth and 5 min after birth were compared among the three groups.Results The incidence of perianesthetic hypertension,hypotension,nausea and vomitting in group C was significantly lower than that in group A and group B(P<0.05).There was no statistically significant difference in the incidence of perianesthetic aspiration among the three groups(P>0.05).The time from entering the room to cutting skin and time from anesthesia to taking out the fetus in group C were(8.2±1.6)and(5.3±0.7)min,which were shorter than those in group A[(15.7±2.6)and(12.2±2.5)min]and group B[(15.6±2.7)and(11.5±2.3)min](P<0.05).The neonatal Apgar scores in group C were(7.8±1.4),(8.6±0.4)and(9.1±0.7)points at birth,1 min after birth and 5 min after birth,which were significantly higher than those in group A[(7.0±0.7),(7.4±0.6),(8.0±0.5)points]and group B[(7.1±0.8),(7.5±0.6),(8.1±0.5)points](P<0.05).Conclusion General anesthesia with tracheal intubation is used to patients undergoing cesarean section after failure of intraspinal delivery analgesia with pulse pump,which has the advantages of less complications,rapid delivery of fetus and reduced risk of neonatal asphyxia.
Intraspinal delivery analgesia with pulse pumpFailure of vaginal deliveryConversionCaesarean sectionGeneral anesthesia with tracheal intubation
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