Effects Of Different Anesthetic Methods On Maternal And Infant Of Patients With Hypertensive Disorders Complicating Pregnancy In Cesarean Section

ObjectiveThis study is to investigate the effects of different anesthetic methods on maternal and infant of patients with hypertensive disorders complicating pregnancy in cesarean section.Methods300 patients with pregnancy-induced hypertension disease undergoing elective cesarean section in our hospital were selected. The patients were aged from 21 to 39 years old, weighed from 50 to 79 kg, The gestation week of the patients were discontent full-term primipara maternal arranged from 37 to 42 weeks or the patients underwent secondary cesarean delivery. By the random number table method, all of the patients were randomly divided into four groups,75 cases per each group:combined general intravenous anesthesia with endotracheal intubation group (group A), subarachnoid block anesthesia (also known as spinal anesthesia or lumbar hemp) group (group B), combined spinal-epidural anesthesia group (group C) and epidural block anesthesia group (group D). Patients of each group were underwent cesarean section with corresponding anesthesia method. General data such as age, body mass index (BMI) and gestational week were recorded. Mean arterial blood pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) were recorded respectively at before anesthesia (T1),5 min after anesthesia (T2),10 min (T3),20 min (T4),30 min (T5), fetal childbirth (T6) and surgery finished (T7). Time of anesthesia used and time of anesthesia onset were recorded in the four different anesthetic methods. The incidence of postoperative adverse reactions such as hypotension (baseline of systolic blood pressure>20%), sinus tachycardia, or sinus bradycardia, waist pain, headache, nausea and vomiting and hypoxemia etc. were determined. The usage of intraoperative vascular active drugs including booster and expand blood vessel drugs etc. were recoeded. Instant’s heart rate of each fetus was recorded before anesthesia, and at 5 min after anesthesia and the onset of surgery. Apgar score and cord blood gas analysis of each newborn were tested at 1 min,5 min and 10 min after delivery. Respiratory depression (Apgar score<7 or pH of umbilical cord blood<7.2) of each neonatal was recorded. The incidence of adverse reactions including nausea and vomiting, headache, backache and puncture redness and the activity of lower limbs were recorded at 24 h and 48 h after surgery. The satisfaction of surgeon and patients for cesarean section surgery with the four different anesthetic methods was evaluated.Results1. There was no statistical significance in age, BMI and gestational week in the four groups (P>0.05).2. Comparison of MAP, HR and SpO2 of each group from Ti to T7:compared to Ti in the same group, MAP and HR of the four groups were lower (P<0.05). Compared to group A, B and C, MAP of group D were higher from T3 to T7(P<0.05). Compared to group B and C, HR of group D at T4 were lower ((P<0.05). Compared to group A and B, HR of group C were decreased (P<0.05) from T5 to T7. There was no statistical significance (P>0.05) in SpO2 from Ti to T7.3. Comparison of time of anesthesia used and time of anesthesia onset between the four groups:time of anesthesia used of group A was longer than that of group B, C and D (P<0.05); time of anesthesia used of group B was shorter than that of group C and D (P<0.05); time of anesthesia used of group C was shorter than that of group D (P<0.05). Time of anesthesia onset of group A was shorter than that of group B and C (P<0.05); there was no statistical significance in time of anesthesia onset between group B and C (P>0.05); time of anesthesia onset of group B and C was shorter than that of group D (P<0.05).4. Comparison of the incidence of postoperative adverse reactions such as hypotension, sinus tachycardia, or sinus bradycardia, waist pain, headache, nausea and vomiting and hypoxemia etc.:compared to group A, there was no statistical significance (P>0.05) in the incidence of postoperative waist pain, headache, nausea and vomiting of group B, C and D. There was no statistical significance(P>0.05) in the incidence of postoperative adverse reactions such as hypotension, sinus tachycardia, or sinus bradycardia and hypoxemia in the four groups.5. Comparison of the usage of intraoperative vascular active drugs including booster and expand blood vessel drugs etc:There was no statistical significance (P>0.05) in the usage of methoxamine in the four groups. There was no statistical significance (P>0.05) in the usage of atropine and nicardipine in the four groups.6. Comparison of instant’s heart rate of each fetus before anesthesia, and at 5 min after anesthesia and the onset of surgery:compared to before anesthesia in the same group, there was no statistical significance (P>0.05) in instant’s heart rate of each fetus at 5 min after anesthesia and the onset of surgery. Compared to group A, there was no statistical significance (P>0.05) in instant’s heart rate of group B, C and D at 5 min after anesthesia and the onset of surgery.7. Comparison of Apgar score and cord blood gas analysis of each newborn at 1 min, 5 min and 10 min after delivery:compared to 1 min after delivery in the same group, There was no statistical significance (P>0.05) in Apgar score of the four groups at 5 min and 10 min after delivery. Compared to group A, There was no statistical significance (P>0.05) in pH value of cord blood in group B, C and D at 5 min and 10 min after delivery.8. Comparison of the incidence of adverse reactions including nausea and vomiting, headache, backache and puncture redness and the activity of lower limbs were recorded at 24 h and 48 h after surgery:There was no statistical significance in the incidence of postoperative adverse reactions such as nausea and vomiting, headache, backache and puncture redness in the four groups at 24 h and 48 h after surgery (P>0.05). The activity of lower limbs of patients in the four groups was not significant at 24 h and 48 h after surgery.9. Comparison of the satisfaction of surgeon and patients for cesarean section surgery with the four different anesthetic.methods:the satisfaction of surgeon and patients for anesthetic method in group B were more than (P<0.05) that in group A and C. The satisfaction of surgeon and patients for anesthetic method in group A and C were more than (P<0.05) that in group D.ConclusionIn the case of no taboos, general intravenous anesthesia with endotracheal intubation, subarachnoid block anesthesia, combined spinal-epidural anesthesia and epidural block anesthesia are suitable for patients with hypertensive disorders complicating pregnancy in cesarean section. Lumbar hemp 25G needle single lumbar hemp is the least trauma of spinal canal anesthesia.