何依红 杨庆耿

【摘要】 目的：探究腰硬联合麻醉对无痛分娩中转剖宫产产妇的镇痛效果及应激反应的影响。方法：选取2017年7月-2019年7月本院收治的无痛分娩中因各种因素转剖宫产产妇150例，按照随机数字表法随机将其分为试验组和对照组，每组75例。试验组采用腰硬联合麻醉，对照组采用无痛分娩留下的导管行硬膜外麻醉。比较两组的疼痛评分、炎症因子水平、应激反应指标及不良反应发生情况。结果：术后3、12、24 h，试验组的VAS疼痛评分均明显低于对照组，差异均有统计学意义（P<0.05）。术后1 d，两组COR、C-P、hs-CRP及TNF-α水平均明显高于麻醉前，差异均有统计学意义（P<0.05）;术后1 d，试验组COR、C-P、hs-CRP及TNF-α水平均显著低于对照组，差异均有统计学意义（P<0.05）。试验组不良反应发生率为16%，明显低于对照组的32%，差异有统计学意义（P<0.05）。结论：腰硬联合麻醉对无痛分娩中转剖宫产产妇的镇痛效果更佳，可有效减轻产妇炎症及应激反应，缓解术后疼痛，同时安全性更高，值得临床推广应用。

【关键词】 腰硬联合麻醉 无痛分娩 剖宫产 应激反应

[Abstract] Objective： To explore the effect of combined spinal-epidural anesthesia on analgesia effect and stress response of the parturient who transferred from painless delivery to cesarean section. Method： A total of 150 women who underwent cesarean section due to various factors during painless delivery admitted to our hospital from July 2017 to July 2019 were selected. According to the random number table method， they were randomly divided into the experimental group and the control group， 75 cases in each group. Combined spinal-epidural anesthesia was used in the experimental group. The control group was given epidural anesthesia using a catheter left over from a painless delivery. Pain scores， levels of inflammatory factors， indicators of stress response and occurrence of adverse reactions were compared between the two groups. Result： 3， 12 and 24 hours after surgery， VAS scores of the experimental group were significantly lower than those of the control group， the differences were statistically significant （P<0.05）. 1 d after surgery， the levels of COR， C-P， hs-CRP and TNF-α in both groups were significantly higher than those before anesthesia， the differences were statistically significant （P<0.05）. 1 d after surgery， the levels of COR， C-P， hs-CRP and TNF-α in the experimental group were significantly lower than those in the control group， the differences were statistically significant （P<0.05）. The incidence of adverse reactions in the experimental group was 16%， significantly lower than 32% in the control group， the difference was statistically significant （P<0.05）. Conclusion： Combined spinal-epidural anesthesia has better analgesic effect on parturient women in painless delivery to cesarean section， can effectively reduce parturient inflammation and stress response， relieve postoperative pain， and is more safe， which is worthy of clinical application.

隨着现代医疗技术及人们生活质量的不断提升，无痛分娩理念广泛应用于临床。无痛分娩在医学上称为分娩镇痛，是使用各种方法使分娩时的疼痛减轻甚至消失，大部分产妇都会选择无痛分娩[1-2]。但部分产妇存在因各种因素导致无痛分娩不顺利，需中转剖宫产的情况，此时麻醉医师需选择适合的麻醉方式[3]。当前临床上主要采用产妇行无痛分娩留下的硬膜外导管继续进行硬膜外麻醉，通常存在麻醉效果并不理想现象，且患者易出现牵拉反应，疼痛剧烈等不良反应[4-5]。因此寻找一个有效的麻醉方式尤为重要。本研究对无痛分娩中转剖宫产患者进行腰硬联合麻醉，观察并分析患者的麻醉效果，现报道如下。

1 资料与方法

1.1 一般资料 选取2017年7月-2019年7月本院收治的无痛分娩中因各种因素转剖宫产产妇150例。（1）纳入标准：年龄>20岁;单胎足月活产产妇。（……