观察不同麻醉方式在妊娠合并心衰患者剖宫产中的应用效果。

选取濮阳市第三人民医院2016年8月至2018年1月收治的51例妊娠合并心衰患者，依据麻醉方法分为全麻组(17例)、硬麻组(17例)和腰硬联合麻醉组(17例)。全麻组接受全身麻醉，硬麻组接受硬膜外麻醉，腰硬联合麻醉组接受腰硬联合麻醉，观察血氧饱和度(SpO₂)变化情况、心衰症状改善情况、产妇及胎儿存活情况。

全麻组术中SpO₂增高至86%左右，胎儿均存活，术后产妇有6例进入重症监护病房；硬麻组切皮、胎儿娩出时产妇未出现躁动，胎儿娩出后心衰症状显著改善，产妇及胎儿均存活，有2例因阻滞效果不佳而于术中加用局麻处理后完成手术，术中心衰症状未明显改善，SpO₂增高至92%左右，产妇有3例出现麻醉后血压骤降；腰硬联合麻醉组麻醉全部成功，胎儿娩出后心衰症状显著改善，SpO₂增高至98%左右，产妇及胎儿均存活。

腰硬联合麻醉阻滞效果较好，可作为妊娠合并心衰患者剖宫产术的首选麻醉方法。

To observe the application effects of different anesthesia methods in cesarean section of pregnant women with heart failure.

Fifty-one pregnant women with heart failure were selected from the Third People's Hospital of Puyang from August 2016 to January 2018. They were divided into general anesthesia group (17 cases), epidural anesthesia group (17 cases) and combined spinal-epidural anesthesia group (17 cases). The general anesthesia group received general anesthesia, the epidural anesthesia group received epidural anesthesia, and the combined spinal-epidural anesthesia group received combined spinal-epidural anesthesia. The changes of blood oxygen saturation (SpO₂), improvement of heart failure symptoms and survival of pregnant women and fetuses were observed.

In general anesthesia group, SpO₂ increased to about 86% during operation, fetuses survived, and 6 parturients entered the intensive care unit after operation. In hard anesthesia group, no restlessness occurred during skin incision and fetal delivery, the symptoms of heart failure improved significantly after fetal delivery, and both parturients and fetuses survived. In 2 cases, local anesthesia was added to complete the operation due to poor blocking effect, but the symptoms of heart failure did not improve significantly during operation, and SpO₂ increased as high as 92%. There were 3 cases of abrupt drop of blood pressure after anesthesia. Anesthesia was successful in combined spinal-epidural anesthesia group, the symptoms of fetal heart failure improved significantly after delivery, SpO₂ increased to about 98%, and both parturients and fetuses survived.

The combined spinal-epidural anesthesia has a good blocking effect and can be used as the preferred anesthesia method for cesarean section in patients with pregnancy complicated with heart failure.