目的 对比研究腰硬联合阻滞麻醉与全身麻醉应用于重度子痫前期剖宫产产妇,对产妇血流动力学和新生儿Apgar评分及脐动脉血气分析的影响.方法 筛选出近两年内患重度子痫前期行剖宫产术的产妇,分为腰硬联合阻滞麻醉(CSEA组)和全身麻醉(GA组)两组.比较两组产妇在麻醉前(T0)、麻醉平稳时(T1)、手术开始时(T2)、胎儿娩出时(T3)、手术结束时(T4)的收缩压(SBP)、舒张压(DBP)、心率(HR)等各指标差异;记录这两组产妇分娩胎儿的手术时长以及胎儿出生后1 min和5 min时的身体状况及脐动脉血气分析.结果 麻醉前(T0),两组产妇各指标差异无统计学意义(P＞0.05).在T1及T2,两组患者SBP、DBP、HR水平均较T0时明显降低(P＜0.05);GA 组 SBP、DBP、HR 水平均高于 CSEA 组(P＜0.05).在 T3两组SBP、DBP、HR水平均较T2时差异有统计学意义(P＜0.05);GA组的SBP、DBP水平均高于CSEA组,但HR的水平低于CSEA组,两者差异有统计学意义(P＜0.05). T4时间点GA组SBP、DBP高于CSEA组(P＜0.05). GA组与CSEA组新生儿1 min Apgar评分≥7者的比例分别为76.7%(23/30)和97.5%(39/40),两组比较差异有统计学意义(P＜0.05). GA 组和 CSEA 组新生儿插管率分别为6.7%(2/30)和2.5%(1/40),新生儿脐动脉pH值分别为7.22±0.36和7.29±0.13,两组比较差异有统计学意义(P＜0.05). GA组和CSEA组麻醉开始至新生儿出生时间分别为(6.0±1.1)min和(14.4±2.1)min,两组比较差异有统计学意义(P＜0.01).结论 两种麻醉均可用于重度子痫前期剖宫产产妇.全麻剖宫产术对产妇血流动力学影响较小,且麻醉起效较快,出婴时间短,但对新生儿Apgar评分及生后脐动脉血气有一定影响.%Objective To evaluate the effect of combined spinal -epidural anesthesia and general anesthesia on maternal hemodynamics and neonate in preeclampsia patients during cesarean section .Methods Seventy patients with preeclampsia, who received cesarean section in our hospital during the last two years , were randomly divided into two groups, combined spinal-epidural anesthesia (CSEA group) and general anesthesia (GA group).The maternal hemody-namic indexes, including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and et al., operation duration, and neonate status and arterial blood gas analysis were compared before anesthesia (T0), at stable an-esthesia (T1), at the beginning of surgery (T2), after delivery of the fetus (T3), and at the end of the surgery (T4). Results There was no significant difference in all maternal indexes between the two groups at T 0 (P＞0.05).The SBP, DBP and HR levels of the two groups were significantly lower at T 1 and T2 than those at T0 (P＜0.05).At T1 and T2, the SBP, DBP, and HR levels in the GA group were significantly higher than those in the CSEA group (P＜0.05).The SBP, DBP, and HR levels were significantly different at T3 between the two groups (P＜0.05).At T3, SBP and DBP levels in the GA group were significantly higher than those in the CSEA group , but the HR level was significantly lower than that in the CSEA group (P＜0.05).At T4, SBP and DBP were significantly higher in the GA group than that in the CSEA group (P＜0.05).The proportions of neonatal one -minute Apgar score ≥7 in the GA group and the CSEA group were 76.7%(23/30) and 97.5%(39/40), with significant difference between the two groups (P＜0.05).The neo-natal intubation rates in the GA and CSEA groups were 6.7%(2/30) and 2.5%(1/40), respectively; as the neonatal umbilical artery pH values were 7.22±0.36 and 7.29±0h13, respectively, with statistically significant differences (P＜ 0.05).The time from anesthesia to birth in GA group and CSEA group were 6.0±1.1 min and 14.4±2.1 min, respec-tively, with significant difference between the two groups (P＜0.01).Conclusion Both anesthesia can be used for cesar-ean delivery in patients with severe preeclampsia .The general anesthesia for cesarean section provide little effect on partu-rient hemodynamics , quick onset and birth duration .But it has a certain influence on the neonatal Apgar score and umbili-cal arterial blood gas .
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