摘要
目的分析“二孩政策”实施后孕产妇结构变化,探讨产科麻醉安全管理。方法选取2012-01/2019-12期间在广西壮族自治区妇幼保健院行剖宫产分娩的产妇22152例进行回顾性分析,以“二孩政策”实施时间点分为2组,政策实施前为A组,实施后为B组。比较不同时期产妇的年龄组成、分娩方式、剖宫产率、手术指征、术中出血量和麻醉方法。结果“二孩政策”实施前后,年龄组成、分娩方式及剖宫产率组间比较差异均有统计学意义(P<0.05);2组主要手术指证没有变化,但B组因瘢痕子宫、前置胎盘、胎盘植入及子宫破裂而手术的病例比率较A组明显增加,差异有统计学意义(P<0.05);B组术中大出血病例比率较A组增加,差异有统计学意义(P<0.05);B组因特殊情况行气管内插管全麻的病例比率较A组增加,差异有统计学意义(P<0.05)。结论“二孩政策”实施后剖宫产率呈下降趋势,但是高龄、危重症孕产妇逐渐增多,产科手术难度高,麻醉风险系数增加。麻醉科医生应主动承担起围手术期生命安全保障的任务,医院应建立以产科、麻醉科为主导的多学科医疗团队,确保围手术期母婴安全。
Objective To analyze the structural changes of pregnant women after the implementation of two-child policy and explore the safety management of obstetric anesthesia.Methods A retrospective analysis was performed on 22,152 women who underwent cesarean section in Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2012 to December 2019.They were divided into two groups according to the implementation time of the“two-child policy”,group A(before the implementation)and group B(after the implementation).The age composition,delivery mode,cesarean section rate,surgical evidence,intraoperative blood loss and anesthesia methods of parturients in different periods were compared.Results Before and after the implementation of two-child policy,there were statistically significant differences in age composition,delivery mode and cesarean section rate among groups(P<0.05).There was no change in the main surgical indications in the two groups,but the rate of surgical cases for scar uterus,placenta previa,placenta implantation and uterine rupture in group B was significantly higher than those in group A,and the difference was statistically significant(P<0.05).Compared with group A,the rate of intraoperative hemorrhage cases in group B increased,and the difference was statistically significant(P<0.05).Compared with group A,the proportion of patients receiving endotracheal intubation under general anesthesia increased in group B,with statistical significance(P<0.05).Conclusion After the implementation of the two-child policy,the cesarean section rate showed a downward trend,but the number of elderly and critically ill pregnant women gradually increased,the difficulty of obstetric operation was high,and the risk coefficient of anesthesia increased.Anesthesiology doctors should take the initiative to ensure perioperative life safety,and hospitals should establish multidisciplinary medical teams led by obstetrics and anesthesiology departments to ensure perioperative maternal and infant safety.
作者
陆以兴
刘思艳
彭伟
LU Yixing;LIU Siyan;PENG Wei(Department of Anesthesiology,Maternal and Child Health Center of Guangxi Zhuang Autonomous Region;Department of Anesthesiology,Reproductive Hospital of Guangxi Zhuang Autonomous Region,Nanning 530000,China)
出处
《麻醉安全与质控》
2021年第6期389-393,共5页
Perioperative Safety and Quality Assurance
基金
广西医疗卫生重点学科建设项目(桂卫科[2019]19号)。
关键词
二孩政策
剖宫产
瘢痕子宫
胎盘植入
麻醉安全
two-child policy
cesarean section
scar uterus
placenta implantation
anesthesia safety
