摘要
目的比较腰硬联合麻醉(combined spinal-epidural anesthesia,CSA)(含非计划性全身麻醉)与CSA联合计划性全身麻醉对凶险性前置胎盘产妇接受剖宫产手术术中效果及预后的影响。方法纳入2015年4月至2017年12月孕28周后于本院超声科诊断为凶险性前置胎盘准备行剖宫产术的产妇106例。采用随机数字表法将产妇分为2组(n=53):①腰硬联合+计划性全身麻醉(spinal+general anesthesia,SGA)组,产妇在腰硬联合麻醉下实施剖宫产、待胎儿取出夹闭脐带后实施全麻;②CSA组:产妇接受常规腰硬联合麻醉。比较两组术中出血量、手术时间、术后转入ICU率、血流动力学参数、血制品的输入量、术后母乳喂养情况以及术后产妇抑郁症的发生率等指标。结果①CSA组因术中不能耐受转为全麻者(CSA-GA组)18例,CSA-GA组产妇术中失血量[(2 994±1 895)vs(1 181±504) mL]及失血量>2 000 mL(12 vs 6例)、术后转入ICU(10 vs 2例)、产后30 d抑郁(16 vs 22例)的发生率高于仅接受常规腰硬联合麻醉(CSA-only)组(P均<0.01)。②SGA组的产妇失血量>2 000 mL(8 vs 18例,P<0.05)、术后转入ICU(3 vs 12例,P<0.05)以及产后30 d抑郁发生比例(11/53 vs 38/53,P<0.01)明显低于CSA组。结论接受剖宫产的凶险性前置胎盘产妇,与非计划性全身麻醉比较,计划全身麻醉可减少术中出血量、降低术中大出血发生率和ICU入住率;计划性全身麻醉可通过改善手术条件降低产后抑郁的发生率。
Objective To evaluate the clinical effectiveness of combined spinal-epidural anesthesia(including unplanned general anesthesia)and planned general anesthesia combined spinal epidural anesthesia for parturients diagnosed with pernicious placenta previa(PPP)undergoing caesarean section.Methods A total of 106 parturients(28 weeks of gestation)diagnosed with PPP by ultrasonography in our hospital during April 2015 and December 2017 were eligible to participate in the study.They were randomly allocated to SGA and CSA groups(n=53).The patients in the SGA group received combined spinal-epidural anesthesia,and general anesthesia was induced after clamping of the umbilical cord.For those in the CSA group,they were given conventional combined spinal epidural anesthesia.The intraoperative bleeding amount,operation time,proportion of ICU admission,hemodynamic parameters,amounts of blood products administered,condition of breastfeeding and incidence of postpartum depression measured by the Edinburgh depression scale were compared between the 2 groups.Results①There were 18 parturients in the CSA group who had to being converted to general anaesthesia due to uncomfortableness during surgery.This group of patients had larger amount of intraoperative bleeding(2 994±1 895 vs 1 181±504 mL),higher ratio of those with the bleeding volume over 2 000 mL(12 vs 6),higher proportion of ICU admission(10 vs 2),and higher incidence of postpartum depression in 30 d after delivery(22 vs 16)when compared to those in the CSA group but not with the conversion(all P<0.01).②The numbers of the patients with bleeding volume>2 000 mL(8 vs 18,P<0.05),of ICU admission(3 vs 12,P<0.05)and the incidence of postpartum depression(11/53 vs 38/53,P<0.01)were significantly lower in the SGA group than the CSA group.Conclusion For the PPP parturients undergoing caesarean section,planned general anaesthesia after delivery of baby is superior to conversion from spinal to general anaesthesia in decreasing intraoperative blood loss,and reducing rates of massive
作者
高宪
朱圆
熊亚
杨贞
王丹
常青
鲁开智
甯交琳
GAO Xian;ZHU Yuan;XIONG Ya;YANG Zhen;WANG Dan;CHANG Qing;LU Kaizhi;NING Jiaolin(Department of Anaesthesiology,Army Medical University (Third Military Medical University),Chongqing,400038,China;Department of Gynaecology and Obstetrics,First Affiliated Hospital,Army Medical University (Third Military Medical University),Chongqing,400038,China)
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2019年第7期684-690,共7页
Journal of Third Military Medical University
关键词
前置胎盘
全身麻醉
腰硬联合麻醉
产后出血
placenta praevia
general anesthesia
combined spinal-epidural anesthesia
postpartum haemorrhage
