Gogarten Wiebke
Department of Anaesthesiology and Intensive Care, University of Müenster, Albert-Schweitzer-Str. 33, Münster D-48 149, Germany.
Best Pract Res Clin Anaesthesiol. 2003 Sep;17(3):377-92. doi: 10.1016/s1521-6896(02)00116-7.
For a long time, epidural anaesthesia has been considered the method of choice for Caesarean delivery. The increased incidence of hypotension by the rapid onset of sympathetic blockade under spinal anaesthesia has been associated with a decline in uteroplacental blood flow and significant fetal acidosis, which may compromise neonatal well-being. Nevertheless, a decrease in fetal pH has not been shown to reduce neonatal Apgar or neurobehavioural assessment scores. Maternal blood pressure can be preserved with little side effects with low doses of vasopressors. On the other hand, spinal anaesthesia conveys significant advantages over epidural anaesthesia such as the simplicity of its use and the speed of onset, which allows neuraxial anaesthesia in urgent Caesarean sections and thus reduces the necessity for general anaesthesia. The small doses of local anaesthetics required to perform spinal anaesthesia reduce the risks of systemic toxicity to zero. Spinal anaesthesia is now considered the method of choice for urgent Caesarean section. The use of intrathecal opioids has profoundly changed the quality of spinal anaesthesia, with improved analgesia, a reduction in local anaesthetic requirements and shorter duration of motor blockade. Preliminary studies indicate that spinal anaesthesia may be safely performed in patients with severe pre-eclampsia, in whom spinal anaesthesia was previously considered contraindicated.
长期以来，硬膜外麻醉一直被视为剖宫产的首选方法。脊髓麻醉下交感神经阻滞快速起效导致低血压发生率增加，这与子宫胎盘血流减少和显著的胎儿酸中毒有关，可能会损害新生儿健康。然而，胎儿pH值降低并未显示会降低新生儿阿氏评分或神经行为评估分数。使用低剂量血管升压药可维持母体血压，且副作用极小。另一方面，脊髓麻醉相对于硬膜外麻醉具有显著优势，例如使用简便、起效迅速，这使得在紧急剖宫产中能够进行神经轴麻醉，从而减少了全身麻醉的必要性。进行脊髓麻醉所需的局部麻醉药剂量小，将全身毒性风险降至零。脊髓麻醉现在被认为是紧急剖宫产的首选方法。鞘内注射阿片类药物的使用深刻改变了脊髓麻醉的质量，镇痛效果改善，局部麻醉药需求减少，运动阻滞持续时间缩短。初步研究表明，脊髓麻醉可在重度子痫前期患者中安全实施，而脊髓麻醉此前被认为在这类患者中是禁忌的。
