Moore T R, Key T C, Reisner L S, Resnik R
Am J Obstet Gynecol. 1985 Jun 15;152(4):404-12. doi: 10.1016/s0002-9378(85)80149-6.
The use of continuous lumbar epidural anesthesia in women with pregnancy-induced hypertension remains controversial. We retrospectively reviewed the charts of 285 women with pregnancy-induced hypertension who were delivered in a 2-year period. Among 185 vaginally delivered patients who received continuous lumbar epidural or local anesthesia, there were no significant differences in the incidence of maternal hypotension, abnormal fetal heart rate tracings, low Apgar scores, or neonatal intensive care unit admissions. Of 100 patients delivered by cesarean section, the incidence of low Apgar scores, depressed umbilical cord pH values, and neonatal intensive care unit admission was increased among those who received general anesthesia (p less than 0.05). However, general anesthesia patients were more likely to have abnormal fetal heart rate tracings (27% versus 4%) requiring urgent delivery. Thus differences in outcome probably reflect poorer fetal condition prior to anesthesia induction rather than a specific anesthetic effect. These results demonstrate that continuous lumbar epidural anesthesia is safe and effective for both the fetus and the mother with pregnancy-induced hypertension.
对于妊娠高血压综合征患者使用连续腰段硬膜外麻醉仍存在争议。我们回顾性分析了285例在两年内分娩的妊娠高血压综合征患者的病历。在185例接受连续腰段硬膜外麻醉或局部麻醉的阴道分娩患者中，产妇低血压、异常胎心监护、低Apgar评分或新生儿重症监护病房收治率方面无显著差异。在100例行剖宫产的患者中，接受全身麻醉者低Apgar评分、脐动脉血pH值降低及新生儿重症监护病房收治率增加（P<0.05）。然而，全身麻醉患者更易出现需要紧急分娩的异常胎心监护（27%比4%）。因此，结局差异可能反映麻醉诱导前胎儿状况较差，而非特定麻醉效果。这些结果表明，连续腰段硬膜外麻醉对妊娠高血压综合征的胎儿和母亲均安全有效。
