【摘要】 目的：探讨妊娠合并肺动脉高压(PAH)产妇剖宫产中应用腰麻-硬膜外联合麻醉对血流动力学和母婴结局的影响。方法：选择2015年2月-2020年3月本院收治的妊娠合并PAH产妇125例为研究对象，按照麻醉方式的不同分为联合组(予以腰麻-硬膜外联合麻醉，n=63)与对照组(予以连续硬膜外麻醉，n=62),比较两组不同时点(麻醉前、麻醉后15min、术毕、术后2h)平均动脉压(MAP)、血氧饱和度(SPO2)、心率(HR)、白介素-1(IL-1)、IL-6、肿瘤坏死因子-α(TNF-α)、ICU滞留时间、住院时间，以及产妇出血率、新生儿死亡率、新生儿窒息率。结果：两组MAP、HR、IL-1、IL-6、TNF-α时点、组间、交互比较有差异(均P<0.05);两组SPO2各时点及交互比较无差异(均P>0.05),而组间比较有差异(均P<0.05)。麻醉后15min,两组IL-1、IL-6、TNF-α比较无差异(均P>0.05);麻醉后15min、术毕、术后2h,联合组MAP、SPO2、HR高于对照组(均P<0.05)。联合组ICU滞留时间、住院时间与对照组无差异，产后出血率、新生儿死亡率、新生儿窒息率与对照组无差异(均P>0.05)。结论：腰麻-硬膜外联合麻醉用于妊娠合并PAH患者剖宫产麻醉，更有利于稳定产妇的血流动力学并降低炎症因子表达。更多还原

【Abstract】 Objective: To explore the effects of combined spinal and epidural anesthesia of pregnant women with pulmonary arterial hypertension(PAH) during cesarean section on their hemodynamics and maternal and infant outcomes.Methods: 125 pregnant women with PAH were selected and were divided into group A(63 women were given combined spinal anesthesia and epidural anesthesia) and group B(62 women were given continuous epidural anesthesia) according to different methods of anesthesia during cesarean section from February 2015 to March 2020.The values of mean arterial pressure(MAP), SPO2, and heart rate(HR), the levels of interleukin(IL)-1, IL-6, and tumor TNF-α, the time of ICU retention, the hospital stay time, the rates of the parturient bleeding and neonatal asphyxia, and the neonatal mortality of the women at different time(before anesthesia, 15 min after anesthesia, end of cesarean section, 2 h after cesarean section) were compared between the two groups.Results: There were significant differences in the values of MAP and HR, and the levels of IL-1, IL-6, and TNF-α of the women among different time, when interaction comparation, and between the two groups(all P<0.05).The SPO2 value of the women in the two groups had no significant difference among different time and when interaction comparation(all P>0.05), but which of the women had significant difference between the two groups(all P<0.05).The values of MAP, SPO2, and HR of the women in group A at 15 min after anesthesia, the end of surgery, and 2 h after surgery were significantly higher than those of the women in group B(all P<0.05).There were no significant differences in ICU stay time and hospital stay time, and postpartum bleeding rate of the women, and the rates of neonatal mortality rate and asphyxia between the two groups(all P>0.05).Conclusion: Combined spinal-epidural anesthesia of the pregnant women with PAH during caesarean section is beneficial to stabilize their hemodynamics and decrease inflammatory factors levels.更多还原