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目的 探讨蛛网膜下隙阻滞麻醉(SA)、硬脊膜外隙阻滞(EA)与经蛛网膜下隙与硬脊膜外隙联合阻滞(CSEA)在剖宫产术中的麻醉效果及对产妇血流动力学的影响.方法 选取2016年1月-2017年1月在该院行剖宫产产妇172例,其中行SA 46例(SA组),EA 55例(EA组),CSEA 71例(CSEA组);观察各组麻醉前(T0)、给药后5min (T1)、给药后15min(T2)、给药后30min(T3)以及手术结束后(T4)的平均动脉压(MAP)、心率(HR)、收缩压(SBP)和舒张压(DBP);同时观察麻醉起效时间、麻醉诱导时间等.结果 SA组和CSEA组麻醉起效时间分别为(1.87±0.64) min和(1.90±0.72) min,明显短于EA组(P＜0.05);SA组麻醉诱导时间为(6.60±1.51) min,明显短于EA组和CSEA组(P＜0.05);CSEA组麻醉诱导时间为(8.10±1.24) min,明显短于EA组(P＜0.05);SA组和CSEA组T1、T2、T3和T4期HR明显低于EA组,而SBP和DBP明显高于EA组(P＜0.05);各组新生儿出生1 min、5min Apgar评分比较差异无统计学意义(P＞0.05);EA组不良反应发生率为23.91％,明显高于SA组和CSEA组(P＜0.05).结论 在剖宫产手术麻醉方式选择上,可首选SA和CSEA,两者麻醉效能较好,且能保证产妇血流动力学相对稳定,不良反应少.“,”Objective To explore the anesthetic effects of subarachnoid anesthesia (SA),epidural anesthesia (EA),and combined spinal epidural anesthesia (CSEA) in cesarean section and the influence on maternal hemodynamics.Methods A total of 172 pregnant women undergoing cesarean section in the hospital from January 2016 to January 2017 were selected and divided into SA group (46 cases),EA group (55 cases),and CSEA group (71 cases).The levels of mean arterial pressure (MAP),heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP) before anesthesia (T0),at 5 minutes after anesthesia (T1),at 15 minutes after anesthesia (T2),at 30 minutes after anesthesia (T3),and after cesarean section in the three groups were observed.The onset time and induction time of anesthesia was observed.Results The onset time of anesthesia in SA group and CSEA group were (1.87 ±0.64) minuts and (1.90±0.72) minutes,respectively,which were statistically significantly shorter than those in EA group (P＜0.05).The induction time of anesthesia in SA group was (6.60±1.51) minutes,which was statistically significantly shorter than those in EA group and CSEA group (P＜0.05).The induction time of anesthesia in CSEA group was (8.10± 1.24) minutes,which was statistically significantly shorter than that in EA group (P＜0.05).HRs at T1,T2,T3,and T4 time points in SA group and CSEA group were statistically significantly lower than those in EA group,while the levels of SBP and DBP in SA group and CSEA group were statistically significantly higher than those in EA group (P＜0.05).There was no statistically significant difference in neonatal one-minute and five-minute Apgar scores among the three groups (P＞0.05).The incidence rates of adverse reactions in EA group was 23.91％,which was statistically significantly higher than those in SA group and CSEA group (P＜0.05).Conclusion On the choice of anesthesic modes in cesarean section,SA and CSEA are preferred,both of them have good anesthetic effect,which can maintain stable hemodynamics and less adverse reactions.