Efficacy And Safety Of Bupivacaine Combined With Fentanyl Spinal Anesthesia For Cesarean Section In Hypertensive Disorder Complicating Pregnancy

Objective:To retrospectively analyze the anesthetic effect of bupivacaine fentanyl isobaric spinal anesthesia for cesarean section of pregnant women with pregnancy induced hypertension and its influence on ICU occupancy rate and Apgar score of fetus,and evaluate the effectiveness and safety of bupivacaine fentanyl isobaric spinal anesthesia for pregnant women with pregnancy induced hypertension,so as to provide reference for clinical anesthesia of pregnant women with different severity of pregnancy induced hypertension.Methods:601 cases of emergency or elective cesarean section in People’s Hospital of Ningxia Hui Autonomous Region from January 2014 to December 2019 were analyzed retrospectively.According to the ninth edition of obstetrics and gynecology diagnostic criteria,they were divided into three groups,non-pregnant hypertension 167 cases（A groups）,214 cases（B group）of mild preeclampsia and 220 cases（C group）of severe preeclampsia respectively.The anesthesia information of three groups was analyzed retrospectively.The age,height,weight,gestational age,ASA grade,Sp O₂and other general information of the three groups were recorded.The systolic blood pressure,diastolic blood pressure and heart rates of the three groups were compared before anesthesia（T₁）,1min after anesthesia（T₂）,5min after anesthesia（T₃）,10min after anesthesia（T₄）,15min after anesthesia（T₅）,5min after fetal delivery（T₆）,10min after fetal delivery（T₇）.Intraoperative hemodynamics such as tension,heart rate,etc.The dosage of vasoactive drugs used during the operation,ICU transfer and complications of the three groups,Apgar score of the three groups at 1 min and5 min after delivery were statistically analyzed.Result:1.There was no significant difference in characteristics between two groups.（P>0.05）.2.Intraoperative hemodynamicsComparison between groups:compared with group A,SBP and DBP of group B at T₁,T₂and T₃were significantly increased,SBP and DBP of group C at T₁-T₇were significantly increased,the difference was statistically significant（P<0.05）;compared with group B,SBP and DBP of group C at T₁-T₆were significantly increased,the difference was statistically significant（P<0.05）;compared with group A,HR of group B at T₁,T₅and T₇was significantly increased Compared with group B（P<0.05）,group C had no significant difference in HR at each time point（P>0.05）;Intra group comparison:compared with T₁,SBP and DBP in group A were significantly decreased at T₂-T₇（P<0.05）.There was no significant difference in SBP and DBP between the three groups at T₂-T₇（P>0.05）.Compared with T_1,HR at T₅and T₆in group A was significantly different（P<0.05）,HR at T₆in group B was significantly different（P<0.05）,HR at T₆in group C was significantly different（P<0.05）.Compared with T₂,HR at T₅,T₆and T₇in group A was significantly different（P<0.05）,HR at T₆in group B was significantly different（P<0.05）,HR at T₆in group C was significantly different（P<0.05）,HR at T₁and T₂in other time points was not significantly different（P>0.05）.3.Use of vasoactive drugs:there was no significant difference in the use of vasoactive drugs among the three groups（P>0.05）.4.The ICU rate of different groups was significantly different（x²=104.765,P<0.001）.The ICU admission rate of severe preeclampsia group was significantly higher than that of mild preeclampsia group and non PIH group.The ICU rate of mild preeclampsia group was significantly higher than that of non PIH group.There was no significant difference in respiratory failure rate and postoperative pulmonary edema rate among different groups（P>0.05）.5.Neonatal Apgar score:there were significant differences in Apgar score of 1 min and Apgar score of 5 min among different groups.The comparison results of group average scores were"non PIH group>severe preeclampsia;mild preeclampsia>severe preeclampsia"Conclusion1.Bupivacaine fentanyl isobaric spinal anesthesia can be used for pregnant women with preeclampsia,intraoperative hemodynamics is stable.2.Bupivacaine fentanyl spinal anesthesia does not increase the incidence of postoperative complications in preeclampsia.