中文摘要：

目的：探讨腰硬联合麻醉（CSEA）对剖宫产围术期患者围术期皮质醇及血浆D-二聚体（D-D）水平变化的影响。方法：选取2014年3月-2015年5月在我院接受剖宫产手术的患者68例为研究对象。.根据术中采用的麻醉方法不同,将患者分为腰硬联合麻醉组（CSEA组）和连续硬膜外麻醉组（CEA组）。观察并比较两组患者围手术期皮质醇及D-二聚体水平的变化情况。结果：两组患者术中纤维蛋白原、凝血活酶时间及凝血酶原时间间比较,差异均无统计学意义（P〉0.05）;两组患者麻醉后皮质醇及D-D水平均显著高于麻醉前,但CSEA组低于CEA组,差异具有统计学意义（P〈0.05）;两组患者D-D水平在手术结束时、术后24 h较麻醉前均显著升高,差异有统计学意义（P〈0.05）;但CSEA组D-D水平在术后24 h及、术后72 h,CSEA组D-D水平均低于CEA组,差异具有统计学意义（P〈0.05）。结论：腰硬联合麻醉可以更好的抑制剖宫产患者术中血清皮质醇及术后血浆D-D水平的升高,有利于改善患者术后高凝状态,值得临床推广应用。

英文摘要：

Objective： To explore the effect of continuous epidural anesthesia（CEA） and combined spinal epidural anesthesia（CSEA） on the perioperative plasma cortisol and D-dimer（D-D） levels in caesarean section. Methods： 69 cases of caesarean section were selected who were treated in our hospital from March June 2014 to May June 2015 were selected as research objects and according to the different methods, the patients were, which were divided into the CSEA group and the CEA group. observed group（36 cases） and control group（33 cases）. Patients in CSEA observed group undergone CSEA and patients in CEA group undergone CEA. Then the levels of perioperative plasma cortisol and D-D between two groups were detected and compared. Results： There was no statistically significant difference about the levels of intraoperative fibrinogen, and the time of activated partial thromboplastin time and prothrombin time had no significant difference between two groups（P〉0.05）; The levels of plasma cortisol and D-D after anesthesia was significantly higher than that before anesthesia in both two groups, and the CESA group was lower than those of the CEA group, and the difference was statistically significant（P〈0.05）, but CESA group was lower than CEA group,; D-D level of both groups at the end of surgery and 24 h after surgery was all significant higher than before anesthesia, and the difference was statistically significant（P〈0.05）; the D-D level of CESA group was lower than CEA group 24 h and 72 h after surgery when compared with before, and the difference was statistically significant（P〈0.05）. Conclusion： CSEA can better inhibit the levels of serum cortisol and plasma D-D of patients with cesarean section when compared with CEA, which can be more conducive to improve postoperative blood high condensation state.