| Objective To compare the differences of different proportion of spinal anesthesia on maternal blood pressure, heart rate and arterial blood gas of neonates effects. Discuss the safer anesthesia on maternal and neonatal.Methods sixty cases of maternal emergency or elective term pregnancy planned cesarean section operation, aged 20-35 years old, weight 60-90 kg, height 155-170 cm, singleton, who were randomly divided into 3 groups, 20 cases in each group. group A is hyperbaric(injected into bupivacaine 15 mg with 10% glucose 1ml), group B is proportion of cerebrospinal fluid(injected into bupivacaine 15 mg with cerebrospinal fluid 1ml), group C is proportion with fentanyl(injected into bupivacaine 15 mg with fentanyl 50ug). Monitoring maternal heart rate(HR), respiratory rate(RR), blood pressure(BP), oxygen saturation(Sp O2) when each groups in the ten time points of anesthesia. Such as before anesthesia(T0), anesthesia(T1), after the success of 1min(T2),3min(T3),5min(T4),10min(T5),30min(T8), before and after the delivery of fetus(T6, T7), at the end of the operation(T9). Record the three groups onset time of anesthesia, the maintenance time and the anesthesia to fetal disengagement time. Record of umbilical artery blood gas and neonatal 1min, 5min Apgar score. Acupuncture method to assess and record the three groups of sensory block level. Observe and record the occurrence of the three groups of maternal intraoperative and postoperative nausea and vomiting, chills, pruritus, respiratory depression and other adverse reactions.Results(1) General information: there was no significant difference between the three groups in age,height, weight and ASA classification(P>0.05).(2) Group comparison: SBP: Group A was lower than that of T0 in T2, T3, T4; group B was lower than that of T0 in T3, T4; group C was lower than that of T0 in T3, T4, T8, the difference was statistically significant(P<0.05). DBP: group A was lower than that of T0 in T2, T3, T4, T5, T8, group B was lower than that of T0 in T3, T4, T8; group C was lower than that of T0 in T3, T4, T5, T8, the difference was statistically significant(P< 0.05). HR: Group A was higher than that of T0 in T3, the difference was statistically significant(P<0.05); compared the heart rate of group B and C were not statistically significant(P> 0.05).(3)Comparison between groups: SBP: compared with group A, in the T4 group A was lower than that of group B and C,in the T2, T5 group A was lower than that of group B; the difference was statistically significant(P<0.05). DBP: compared with group A, in the T2,T5,T8, group A was lower than that of group B; in the T3,T4, group A was lower than that of group B and C, the difference was statistically significant(P<0.05). HR: compared with group A, in the T3 group A was higher than that in group B and C, in the T2 group A than that of group B, the difference was statistically significant(P<0.05).(4)The three group received single spinal needle anesthesia, each group of the highest level of sensory block and the duration can meet the operation requirements. The onset time of anesthesia in group A was significantly faster than group B and C, the difference was statistically significant(P<0.01); group C was significantly longer duration of anesthesia than group A and B, the difference was statistically significant(P<0.01).(5) Compared with the dose of phenylephrine in the three groups,group A was higher than that of group B and C, the difference was statistically significant(P<0.05).(6) Comparison of umbilical arterial blood gas and 1 and 5 minute Apgar score between the three groups, the difference was not statistically significant(P> 0.05).(7) The incidence of pruritus in three groups after postoperative, group C was significantly higher than group A and B, the difference was statistically significant(P<0.05); nausea, vomiting, chills and bradycardia had no significant differences between three groups(P>0.05).Conclusion Single needle hyperbaric spinal anesthesia and isobaric spinal anesthesia were suitable anesthesia for cesarean section. But the isobaric spinal anesthesia is faster onset time, anesthesia effect was perfect, maternal blood pressure fluctuation was small; Isobaric spinal anesthesia with fentanyl 50 ug on neonatal Apgar score and umbilical arterial blood gas without adverse effects. |
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