张正毓　熊森彪　李守荣

[摘要] 目的 观察腰麻-硬膜外联合阻滞（CSEA）和硬膜外麻醉（EA）在剖宫产术中的临床效果，探讨CSEA在剖宫产术中的可行性。 方法 选择ASA Ⅰ～Ⅱ级足月剖宫产产妇90例，随机分成A组（CSEA组）45例和B组（EA组）45例，记录两组椎管内麻醉阻滞情况、术中呼吸循环功能、麻醉效果及不良反应情况。 结果 两组SBP、DBP、HR麻醉后均有一过性降低，正确处理后呼吸循环功能趋向稳定，不良反应、新生儿Apgar评分差异无统计学意义（P>0.05），A组的麻醉效果明显优于B组（P<0.05）。 结论 剖宫产手术使用CSEA麻醉效果确切，肌松良好，起效时间快，并发症少，手术的可行性、舒适性明显优于EA法。

[关键词] 剖宫产术；腰麻-硬膜外联合阻滞；硬膜外麻醉；临床效果

[中图分类号] R614.4 [文献标识码] A [文章编号] 1674-4721（2014）04（a）-0097-03

[Abstract] Objective To observe the clinical effect of epidural anesthesia（EA） and combined spinal and epidural anesthesia（CSEA） in cesarean section，so as to investigate the feasibility of CSEA in cesarean section. Methods 90 cases of full-term cesarean section puerperaes with ASA Ⅰ-Ⅱ were selected and they were all divided into A group（CSEA group） and B group（EA group），with 45 cases in each group.The spinal anesthesia block，intraoperative breathing and circulation function，anesthesia effect and adverse reaction of the two groups were recorded. Results Both the two groups of SBP，DBP，HR were all lower after anesthesia，and the respiratory and circulatory function tended to stable after correct treatment.The differences of adverse reactions，neonatal Apgar score between the two groups were all no statistically significant（P>0.05）.The anesthesia effect in A group was obviously better than that of B group（P<0.05）. Conclusion The anesthesia effect of CSEA applied to in cesarean section is obvious，and with good muscle relaxation，quick effect time，fewer complications.The feasibility and comfort of CSEA is obviously higher than that of EA method.

[Key words] Cesarean section；Combined spinal epidural anesthesia；Epidural anesthesia；Clinical effect

硬膜外麻醉（epidural anesthesia，EA）具有止痛效果可靠、麻醉平面和血压控制较容易、宫缩无明显抑制、对胎儿呼吸循环无抑制[1]、可以作为术后硬膜外镇痛疗法等优点，被广泛应用于剖宫产术中，是多年来国内主要的麻醉方法。近年来，腰麻-硬膜外联合阻滞（combined spinal and epidural anesthesia，CSEA）既保留了腰麻起效快、镇痛完善与肌松良好的优点，也便于调整麻醉平面，防止麻醉平面过高，还可以通过硬膜置管追加局麻醉药弥补麻醉阻滞平面不足或阻滞时间不够的缺点[2]，可满足较长手术和术后硬膜外镇痛要求，是我院剖宫产手术的首选麻醉方式。本研究通过观察CSEA和EA在剖宫产术中的临床效果，探讨CSEA在剖宫产术中的可行性。

1 资料与方法

1.1 一般资料

选择本院妇产科2012年1月～2013年5月行剖宫产手术的ASA Ⅰ～Ⅱ级孕龄足月产妇90例；年龄19～44岁，平均28岁；体重44～92 kg，平均68 kg；身高140～170 cm；所有产妇均足月、单胎，无妊娠高血压综合征、先兆子痫、椎管麻醉穿刺禁忌证，排除合并精神心理性疾病、头痛及其他合并脏器功能障碍的产妇。均……