季淋淋 1陆佳超 2张冰 1卢园园 1郑声星 1胡明品1
作者信息
- 1. 325000 温州医科大学附属第二医院、育英儿童医院麻醉与围术期医学科
- 2. 嘉兴市第一医院麻醉科
- 折叠
摘要
Abstract
Objective To investigate the analgesic efficacy and safety of dural puncture epidural(DPE)block in cesarean section.Methods A total of 135 parturients undergoing elective cesarean section at the Second Affiliated Hospital of Wenzhou Medical University from June 2021 to September 2022 were randomly divided into three groups with 45 cases in each group,and epidural block(EP group),dural puncture epidural block(DPE group)and combined sponal-epidural block(CSE group)were used for anesthesia,respectively.The intraoperative oxytocin dosage,fluid infusion volume,blood loss,and 1 min and 5 min Apgar scores of newborns were compared among three groups.The anesthesia effects,including sensory blockade level,degree of traction response,and relaxation score were observed.The changes of systolic blood pressure(SBP)and heart rate(HR)were monitored at entering operation room,disinfecting and draping,skin incision,fetal delivery,abdominal cavity cleaning and the end of surgery.The adverse reactions,total dosage of norepinephrine,and administration of propofol were recorded in three groups.Results There were no significant differences in the general conditions,intraoperative oxytocin dosage,infusion volume,blood loss,and 1 min and 5 min Apgar scores of newborns among the three groups of parturients(all P＞0.05).The time from administration to reaching the T6 plane and from administration to skin incision in the EP group was longer than that in the DPE group and CSE group(P＜0.01).The highest level of sensory nerve block in the CSE group and DPE group was higher than that in the EP group(P＜0.01).The number of grade Ⅰ traction reactions during surgery in the CSE group and DPE group was significantly higher than that in the EP group(P＜0.01),while the number of grade Ⅲ reactions was significantly lower than that in the EP group(P＜O.01).The relaxation scores during surgery in the CSE and DPE groups were significantly higher than those in the EP group(P＜0.01).The average SBP of the CSE group was lower than that of the EP group and DPE group(P＜0.01),while the average HR was higher than that of the EP group and DPE group(P＜0.01)during disinfecting and draping.The overall incidence of adverse reactions in the CSE group was significantly higher than that in the EP and DPE groups(P＜0.01).The dosage of norepinephrine used in the EP and DPE groups was lower than that in the CSE group(P＜0.01),and the use of propofol in the EP group was significantly higher than that in the CSE and DPE groups(P＜0.05).Conclusion Compared with CSE block,DPE block takes shorter time to achieve adequate analgesia effect in cesarean section,and it is also associated with less adverse reactions and better hemodynamic stability,indicating that DPE blosk is worthy of clinical promotion.关键词
剖宫产术/硬脊膜穿破硬膜外阻滞/蛛网膜下腔-硬膜外联合阻滞/硬膜外阻滞/麻醉效果Key words
Cesarean section/Dural puncture epidural/Combined spinal-epidural block/Epidural block/Anesthetic effect
