不同麻醉方案对超体重剖宫产产妇循环系统、泌乳素及母婴结局的影响对比

Comparison of the effects of different anesthesia regimens on circulatory system, prolactin and maternal and neonatal outcomes in overweight women undergoing cesarean section

摘要

目的 探讨不同麻醉方案对超体重剖宫产产妇[孕前体质量指数(BMI)在25~35kg/m²之间]循环系统、泌乳素(PRL)及母婴结局的影响。方法 选取2022年3月至2023年10月在厦门大学附属中山医院行剖宫产手术的80例超体重产妇为研究对象,根据麻醉方案的不同分为连续性硬膜外麻醉组49例和蛛网膜下腔麻醉组31例.比较两组麻醉效果,记录麻醉前(T0)、麻醉5min(T1)及胎儿娩出时(T2)产妇心率(HR)、舒张压(DBP)、收缩压(SBP)变化情况,对比两组手术前后血清PRL、多巴胺(DA)、去甲肾上腺素(NE)、肾上腺素(E)水平差异、母婴结局、术后恢复情况及不良反应发生情况。结果 蛛网膜下腔麻醉组麻醉起效时间短于连续性硬膜外麻醉组,肌松效果优于连续性硬膜外麻醉组,差异有统计学意义(t/Z值分别为3.958、6.639,P<0.05);两组T0、T1、T2时刻HR波动不显著(P>0.05),两组DBP、SBP均经历先下降再上升的过程(F值介于20.561~279.940之间,P<0.05);T1时刻,蛛网膜下腔麻醉组DBP、SBP高于连续性硬膜外麻醉组,差异有统计学意义(t值分别为2.929、4.158,P<0.05);两组术后血清PRL、DA、NE、E水平均较术前升高,差异有统计学意义(t值介于4.776~27.062之间,P<0.05);与蛛网膜下腔麻醉组相比,术后连续性硬膜外麻醉组血清PRL水平较低,血清DA、NE、E水平较高,差异有统计学意义(t值介于2.387~3.076之间,P<0.05);两组术中/术后24h视觉模拟疼痛(VAS)评分、术中出血量、术中输液量、胎儿娩出时间、新生儿Apgar评分、40项恢复质量量表(QoR-40)各维度评分及总分、不良反应发生率比较,差异均无统计学意义(P>0.05)。结论 连续性硬膜外麻醉与蛛网膜下腔麻醉应用于超体重剖宫产产妇效果相当,后者对于产妇的循环系统和泌乳素分泌影响更小.

Abstract

Objective To investigate the effects of different anesthesia regimens on circulatory system, prolactin (PRL) and maternal and neonatal outcomes in overweight women undergoing cesarean section [pre-pregnancy body mass index (BMI) between 25 and 35kg/m²]. Methods A total of 80 overweight women who underwent cesarean section at Zhongshan Hospital Xiamen University between March 2022 and October 2023 were enrolled. According to the anesthesia regimen, patients were divided into a continuous epidural anesthesia group (n=49) and a subarachnoid anesthesia group (n=31). Anesthetic effects were compared between groups. Maternal heart rate (HR), diastolic blood pressure (DBP), and systolic blood pressure (SBP) were recorded at three time points: before anesthesia (T0), 5min after anesthesia (T1), and at fetal delivery (T2). Serum levels of PRL, dopamine (DA), norepinephrine (NE), and epinephrine (E) before and after surgery, maternal and neonatal outcomes, postoperative recovery, and adverse events were analyzed. Results The onset time of anesthesia was shorter and muscle relaxation was better in the subarachnoid anesthesia group than in the continuous epidural anesthesia group (t/Z=3.958 and 6.639, respectively, P<0.05). No significant differences in HR were observed between groups at T0, T1, and T2 (P>0.05). Both groups exhibited a decrease followed by an increase in DBP and SBP over time (F values ranged from 20.561 to 279.940, P<0.05). At T1, DBP and SBP were significantly higher in the subarachnoid anesthesia group than in the continuous epidural anesthesia group (t=2.929 and 4.158, respectively, P<0.05). Postoperative serum levels of PRL, DA, NE, and E were all significantly elevated compared with preoperative levels (t values ranged from 4.776 to 27.062, P<0.05). Compared with subarachnoid anesthesia group, the serum PRL level in continuous epidural anesthesia group was lower, and the serum DA, NE and E levels were higher, with statistical significance (t values ranged from 2.387 to 3.076, P<0.05). No statistically significant differences were observed between the two groups in intraoperative/postoperative 24-hour Visual Analog Scale (VAS) pain scores, intraoperative blood loss, intraoperative fluid infusion volume, fetal delivery time, neonatal Apgar scores, dimensions or total scores of quality of recovery-40 questionnaire (QoR-40), or the incidence of adverse reactions (P>0.05). Conclusion Continuous epidural anesthesia and subarachnoid anesthesia produce comparable anesthetic effects in overweight women undergoing cesarean section. However, subarachnoid anesthesia has a milder impact on maternal circulatory function and prolactin secretion.

关键词

超体重 / 产妇 / 剖宫产术 / 连续性硬膜外麻醉 / 蛛网膜下腔麻醉 / 循环系统 / 泌乳素 / 母婴结局

Key words

overweight / parturient / cesarean section / continuous epidural anesthesia / subarachnoid anesthesia / circulatory system / prolactin / maternal and neonatal outcome

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