佘锐璇

[關键词] 硬膜外阻滞;蛛网膜下阻滞;剖宫产;新生儿;血气分析

[中图分类号] R719.8          [文献标识码] B          [文章编号] 1673-9701（2021）14-0131-04

The effect of epidural block and subarachnoid block for cesarean section on umbilical cord blood gas of newborn

SHE Ruixuan

Department of Anesthesiology， Foshan Maternal and Child Health Hospital， Foshan   528000， China

[Abstract] Objective To investigate the influence of epidural block and subarachnoid block for cesarean section on neonatal umbilical cord blood gas analysis. Methods 200 cases of cesarean section women who gave birth in our hospital from March to October 2020 were randomly divided into the control group （n=100） and the study group （n=100）. The control group was given continuous epidural analgesia for labor analgesia. The study group was given subarachnoid block. The related indexes of anesthesia and analgesia， anesthesia-related complications， the umbilical cord blood gas analysis index of newborns after birth， and Apgar scores in each period between two groups were compared. Results The time for the sensory block level to return to normal and the time to reach the maximum sensory block level in the study group were shorter than those in the control group （P<0.05）. The difference in the maximum visual analogue scale （VAS） score and the time required to relieve pain between the two groups was not statistically significant （P>0.05）. The mean arterial pressure （MAP） of the study group at 10， 30， and 60 minutes of analgesia was lower than that of the control group （P<0.05）. There was no statistically significant difference in the MAP of immediate analgesia between the two groups （P>0.05）. There was no significant difference in the incidence of nausea and vomiting， hypotension， bradycardia， chills and other anesthesia-related complications between the two groups（P>0.05）. There was no statistical difference（P>0.05） in the cord blood gas analysis indexes after birth， including pH， partial pressure of carbon dioxide（PaCO2）， partial pressure of oxygen （PaO2）， residual alkali （BE）， and Apgar scores at 1， 5， and 10 minutes between the two groups of newborns. Conclusion Compared with epidural block， the subarachnoid block has a smaller drug dosage， better comprehensive anesthesia effect， and less impact on the fetus and the puerpera. It will not increase the anesthesia-related complications and is worthy of clinical promotion.

[Key words] Epidural block; Subarachnoid block; Cesarean section; Newborn; Blood gas analysis

妇产科最多见的手术是剖宫产，而手术麻醉方案的差异对产妇所产生的影响也有所不同，并且因胎儿-胎盘之间的血液循环互相连通，也会对胎儿产生一定影响[1]。另外，因剖宫产产妇受精神紧张、术前宫缩痛、焦虑情绪的综合影响，导致其围术期应激反应有所加剧，因此在进行麻醉方案选择时，怎样将对产妇及胎儿产生的消极影响最大化降低尤为重要[2]。剖宫产手术操作时间较短，大部分产妇均与椎管内麻醉指征相符，硬膜外阻滞与蛛网膜下阻滞是常用的椎管内麻醉方式，可在短时间内迅速起效，获取理想的镇痛效果及肌松状态[3-4]。本研究选取200例剖宫产产妇，对比硬膜外阻滞与蛛网膜下阻滞行剖宫产的镇痛效果及对新生儿脐带血血气分析的影响，现报道如下。

1 资料与方法

1.1 一般资料

纳入2020年3至10月本院分娩的200例剖宫产产妇为研究对象，随机分为对照组和研究组，各100例。对照组产妇年龄21～34岁，平均（27.63±4.76）岁;初产妇与经产妇比例为79/21;体质量指数（BMI）介于25.72～30.47 kg/m2，平均BMI为（26.72±3.07）kg/m2;术前美国麻醉医师协会（ASA）分级：63例Ⅰ级，37例Ⅱ级;平均手术时间（66.52±9.27）min。研究组产妇年龄21～36岁，平均（27.81±5.04）岁;初产妇与经产妇比例为76/24;体质量指数（BMI）25.93～30.29 kg/m2，平均BMI为（26.34±3.22）kg/m2;术前美国麻醉医师协会（ASA）分级：65例Ⅰ级，35例Ⅱ级;平均手术时间（66.14±9.52）min。两组基线资料对比，差异无统计学意义（P>0.05），具有可比性。纳入标准：产妇与剖宫产指征相符;年龄>18岁;认知功能良好;单胎妊娠;无椎管内麻醉禁忌证;凝血功能正常;知晓本研究内容并签署知情同意书。排除标准……