刘文勇 高华敏

[摘要] 目的 探讨剖宫产手术椎管内麻醉妇女神经损伤的发生率和影响因素。方法 整群选取2014年1月—2015年7月于重庆市九龙坡区妇幼保健院和九龙坡区第五人民医院286例实施子宫下段剖宫产的妇女纳入研究对象，按照是否发生神经损伤分为神经损伤组（31例）和未神经损伤组（255例），根据是否存在异感分为异感组（23例）和无异感组（263例）。对比产妇麻醉后1～10 d的感觉障碍及疼痛的位置和性质，探讨椎管内麻醉妇女神经损伤的影响因素。结果 286例剖宫产妇女中发生神经损伤31例（10.8%）， 8例将泵拔出后好转，14例由于置管和穿刺时的损伤引起，9例无明确原因，均于10 d之内逐渐恢复。286例剖宫产妇女中异感发生23例（8.0%），异感组的神经损伤发生率明显高于无异感组，差异具有统计学意义（P<0.05）。对可能会引发剖宫产椎管内麻醉妇女神经损伤的12个因素进行多因素Logistic回归分析发现轻度水肿和出现异感为剖宫产手术麻醉妇女神经损伤的影响因素。结论 出现异感为神经损伤的危险因素，而轻度水肿有利于缓解神经损伤的发生，麻醉时应规范操作步骤，减少异感的发生。

[关键词] 剖宫产；椎管内麻醉；神经损伤；影响因素

[中图分类号] R714；R782.05+4 [文献标识码] A [文章编号] 1674-0742（2016）03（c）-0078-02

Research on Influence Factors of Intraspinal Anesthesia in Caesarean Section for Nerve Injury of Women

LIU Wen-yong1，GAO Hua-min2

1. Jiulongpo District Maternal and Child Health Care Hospital， Chongqing， 400080 China； 2. Jiulongpo District Fifth People's Hospital， Chongqing， 400014 China

[Abstract] Objective To discuss the incidence rate and influence factors of intraspinal anesthesia in caesarean section for nerve injury of women. Methods 286 cases of women with low cesarean section treated in the Jiulongpo District Maternal and Child Health Hospital of Chongqing and Jiulongpo District Fifth People's Hospital from January 2014 to July 2015 were selected as the research object and divided into the nerve injury group （31 cases） and nerve uninjuried group （255 cases）according to whether the nerve injury occurred or not and divided into the paresthesia group （23 cases） and the non-paresthesia group （263 cases） according to whether the –paresthesia occurred or not ， the sensory disturbance and the location and nature of pain of the puerperas in 1d-10d after anaesthesia were compared， and the influence factors of intraspinal anesthesia for nerve injury of women were discussed. Results 31 cases were with nerve injury in the 286 cases of women with caesarean section （10.8%）， 8 cases were improved after the pump was pulled out， 14 cases were caused by the injury at the time of catheterization and puncture， 9 cases were without clear reasons and gradually recovered in 10 days， the paresthesia occurred to 23 cases in the 286 cases of women with caesarean section （8.0%）， the incidence rate of nerve injury in the paresthesia group was obviously higher than that in the non- paresthesia group， and the difference was statistically significant （P<0.05）， the multivariate logistic regression analysis of 12 factors may leading to nerve injury of women by intraspinal anesthesia in caesarean section discovered that the mild edema and occurrence of paresthesia were the influence factors of intraspinal anesthesia in caesarean section for nerve injury of women. Conclusion The occurrence of paresthesia is the risk factor of nerve injury， and the mild edema is conducive to relieving the occurrence of nerve injury， and the operating steps should be standardized at the time of anesthesia to reduce the occurrence of paresthesia.

[Key words] Caesarean section； Intraspinal anesthesia； Nerve injury； Influence factor

产科实施麻醉的关键是要保重产妇和婴儿的安全，并降低产妇分娩时的痛苦[1]。目前国内实施剖宫产术和无痛分娩的产妇不断增长，实施椎管内麻醉的妇女也相应的增加[2]。近年来有报道椎管内麻醉会对产科妇女的神经系统损伤。发生损伤的原因比较复杂，且损伤机制尚不明了[3]，该研究整群选取2014年1月—2015年7月两家医院收治的286例实施子宫下段剖宫产妇女为研究对象，现报道如下。

1 资料与方法

1.1 一般资料

研究对象为整群选取2014年1月—2015年7月于重庆市九龙坡区妇幼保健院和九龙坡区第五人民医院实施子宫下段剖宫产的妇女286例，ASA分级为Ⅰ级或者Ⅱ级，且均无精神和神经系统的疾病。……