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| 全凭静脉麻醉和硬膜外麻醉对重度子痫前期产妇颅内压的影响 |
| Influence of total intravenous anesthesia and epidural anesthesia on intracranial pressure in women with severe preeclampsia |
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| DOI：10.12089/jca.2021.11.009 |
| 中文关键词: 视神经鞘直径 重度子痫前期 全凭静脉麻醉 硬膜外麻醉 颅内压 |
| 英文关键词: Optic nerve sheath diameter Severe preeclampsia Total intravenous anesthesia Epidural anesthesia Intracranial pressure |
| 基金项目: |
| 作者 | 单位 | E-mail | | 陈曦 | 230001,合肥市,中国科学技术大学附属第一医院（安徽省立医院）麻醉科 | | | 谢春林 | 230001,合肥市,中国科学技术大学附属第一医院（安徽省立医院）麻醉科 | 116352258@qq.com | | 周维德 | 230001,合肥市,中国科学技术大学附属第一医院（安徽省立医院）麻醉科 | | | 宋幽平 | 230001,合肥市,中国科学技术大学附属第一医院（安徽省立医院）麻醉科 | | | 疏树华 | 230001,合肥市,中国科学技术大学附属第一医院（安徽省立医院）麻醉科 | |
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| 中文摘要: |
目的 剖宫产围术期使用超声通过测定接受全凭静脉麻醉或硬膜外麻醉的重度子痫前期孕妇的视神经鞘直径（ONSD），间接评估两种麻醉
方法 对重度子痫前期产妇颅内压的影响。
方法 选择拟行剖宫产术的重度子痫前期产妇60例，年龄20～45岁，ASA Ⅲ级。随机分为两组：全凭静脉麻醉组（GA组）和硬膜外麻醉组（EA组），每组30例。GA组接受全凭静脉麻醉气管插管，EA组使用1%利多卡因+0.375%罗哌卡因硬膜外注射麻醉，记录麻醉前即刻、麻醉后5 min（气管插管后5 min或麻醉平面达到脊神经T8水平后5 min）、胎儿娩出后5 min和术后30 min时ONSD、HR和BP。并收集新生儿1、5 min Apgar评分，新生儿辅助通气/插管率和麻醉前即刻和术后24 h头痛、视物模糊等颅内高压症状发生情况。
结果 麻醉后5 min、胎儿娩出后5 min和术后30 min GA组ONSD值均明显低于EA组（P＜0.05 ）。麻醉后5 min和胎儿娩出后5 min GA组HR明显慢于EA组（P＜0.05），麻醉后5 min GA组MAP明显低于EA组（P＜0.05），胎儿娩出后5 min GA组MAP明显高于EA组（P＜0.05），其余时点两组HR、MAP差异无统计学意义。两组新生儿1、5 min Apgar评分和新生儿辅助通气/插管率差异无统计学意义。术后24 h GA组头痛和视物模糊等颅内高压症状好转率明显高于EA组（P＜0.05 ）。
结论 与硬膜外麻醉比较，全凭静脉麻醉能更好地降低重度子痫前期产妇的颅内压，改善重度子痫前期的颅内高压症状，对新生儿无明显不良影响。 |
| 英文摘要: |
Objective To indirectly evaluate the effects of total intravenous anesthesia or epidural anesthesia on intracranial pressure in pregnant women with severe preeclampsia during the perioperative period of cesarean section, the optic nerve sheath diameter (ONSD) was measured by ultrasound.
Methods Sixty cases of women with severe preeclampsia, aged 20-45 years, ASA physical status Ⅲ, scheduled for cesarean section, were randomly divided into general anesthesia group (group GA) and epidural anesthesia group (group EA). Group GA received total intravenous anesthesia and endotracheal intubation. Group EA was given epidural injection of 1% lidocaine+0.375% ropivacaine. ONSD, HR and BP were recorded immediately before anesthesia, 5 minutes after anesthesia (5 minutes after endotracheal intubation or 5 minutes after anesthesia level reached T8 level of spinal nerve), 5 minutes after fetal delivery and 30 min after operation. The Apgar scores of newborns at 1 and 5 minutes, assisted ventilation/ intubation and the occurrence of intracranial hypertension symptoms such as headache and blurred vision immediately before anesthesia and 24 hours after operation were collected.
Results 5 minutes after anesthesia, 5 minutes after fetal delivery and 30 minutes after operation, the ONSD value in group GA was significantly lower than that in group EA (P < 0.05). The heart rate in group GA was significantly lower than that in group EA 5 minutes after anesthesia and 5 minutes after fetal delivery (P < 0.05). The mean arterial pressure in group GA was significantly lower than that in group EA 5 minutes after anesthesia (P < 0.05), and the mean arterial pressure in group GA was significantly higher than that in group EA 5 minutes after delivery (P < 0.05). There was no significant difference in heart rate and mean arterial pressure between the two groups at other time points. There was no significant difference in Apgar score at 1 and 5 minutes and incidence of mask assisted ventilation or endotracheal intubation in newborns between the two groups. Intracranial hypertension symptoms such as headache and blurred vision were significantly more improved in group GA than group EA 24 hours after operation (P < 0.05).
Conclusion Total intravenous anesthesia can significantly reduce the intracranial pressure of S-PE, which is conducive to improve the symptoms of S-PE intracranial hypertension, and has no obvious adverse effects on newborns. |
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