不同麻醉方法对前置胎盘剖宫产产妇和胎儿的影响
Effects of Different Anesthetic Methods on Parturient and Fetus with Cesarean Section due to Placenta Previa
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摘要: 目的 回顾分析不同麻醉方法对前置胎盘剖宫产产妇和胎儿的影响, 为临床麻醉工作提供可行性参考.方法 选取2015年1月至2017年10月间, 因前置胎盘在昆明市第一人民医院产科行剖宫产手术产妇73例为观察对象, 按照麻醉方式不同分为椎管内麻醉组和全身麻醉组, 观察比较2组产妇术中情况, 包括手术时间、术中失血量、输液量和升压药应用率, 以及新生儿情况, 包括断脐 (I-D) 时间、脐动脉血p H、PCO2、PO2、娩出后1、5 min Apgar评分.结果 全身麻醉组45例, 椎管内麻醉组28例 (其中硬膜外13例, 腰硬联合15例) , 有2例产妇行椎管内麻醉后阻滞不全改全麻醉, 4例产妇因出血量大改全麻, 麻醉方法计为全麻.2组产妇一般情况差异无统计学意义, 全身麻醉组患者手术时间、术中失血量、升压药应用率及输液量均明显高于椎管内麻醉组 (P<0.05) ;2组产妇娩出新生儿断脐 (I-D) 时间、脐动脉血p H、PCO2、PO2、娩出后1、5 min Apgar评分比较无明显差异 (P>0.05) .结论 对于完全性前置胎盘患者或术前估计出血量大的产妇, 选择全身麻醉对产妇和新生儿更安全, 但其他类型患者, 其麻醉方法的选择上同样应视具体情况而定.Abstract: Objectives To retrospectively analyze the effects of different anesthetic methods on parturient and fetus with cesarean section due to placenta previa and to provide a feasible reference for clinical anesthesia.Me thods From January 2015 to October 2017, 73 cases of parturient undergoing cesarean section due to placenta previa were selected and divided into intraspinal anesthesia group and general anesthesia group. The intraoperative conditions of parturient of the two groups were observed and compared, including the operation time, intraoperative blood loss, infusion volume and application rate of pressor agent, as well as the neonatal conditions, including omphalotomy (I-D) time, umbilical arterial blood p H, PCO2, PO2 and Apgar score 1 min and 5 min after delivery.Re s ults There were 45 cases in general anesthesia group, 28 cases in intraspinal anesthesia group (13 cases with epidural and 15 cases combined with spinal and epidural anesthesia) . Two cases were changed to general anesthesia after intraspinal anesthesia because of incomplete retardation and four cases were also changed to general anesthesia because of large amount of bleeding. There was no significant difference in general conditions between the two groups. The operative time, intraoperative blood loss, application rate of pressor agent and infusion volume in the general anesthesia group were significantly higher than those in the intraspinal anesthesia group (P < 0.05) .There was no significant difference in the omphalotomy (I-D) time, umbilical arterial blood p H, PCO2, PO2 and Apgar score 1 min and 5 min after delivery between the two groups (P>0.05) .Conclus ion For patients with complete placenta previa or large estimated preoperativebleeding volume, it is safer to choose general anesthesia for puerpera and newborns, but for other types of patients, the choosing of anesthesia methods should depend on specific conditions.
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Key words:
- General anesthesia /
- Epidural anesthesia /
- Neonatal blood gas analysis /
- Apgar score
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[1]路思思, 邹丽.凶险性前置胎盘致产后大出血的防范[J].中国实用妇科与产科杂志, 2014, 30 (4) :256-259. [2]谢言虎, 凡小庆, 高燕春, 等.瘢痕子宫合并前置胎盘剖宫产麻醉回顾性分析[J].临床麻醉学杂志, 2015, 31 (10) :1026-1028. [3]周欣, 张国英, 孙丽洲, 等.凶险型前置胎盘围术期综合手术治疗方法探讨[J].实用妇产科杂志, 2013, 29 (7) :516-518. [4]中华医学会妇产科学分会产科学组.前置胎盘的临床诊断与处理指南[J].中华妇产科杂志, 2013, 48 (2) :148-150. [5]葛俊丽, 曾蔚越, 段丽君, 等.前置胎盘类型与妊娠结局[J].实用妇产科杂志, 2011, 27 (6) :448-452. [6]陈燕, 高昌俊, 肖志彬.凶险型前置胎盘术中大出血麻醉处理1例[J].实用医学杂志, 2012, 28 (3) :476. [7] [7]IOSCOVICH A, SHATALIN D, BUTWICK A J, et al.Israeli survey of anesthesia practice related to placenta previa and accreta[J].Acta Anaesthesiol Scand, 2016, 60 (4) :457-464. [8] [8]HAKIMOGLU S, KARCIOGLU M, TUZCU K.Evaluation of complications and anesthesia practice in cases with cesarean section for placenta previa[J].Middle East Journal of Internal Medicine, 2014, 7 (1) :20-25. [9]杨红梅, 陈锰, 刘兴会.凶险性前置胎盘的围生期管理[J].实用妇产科杂志, 2017, 33 (9) :641-643. [10]倪燕, 周钦海, 蒋秀红, 等.急性等容血液稀释在完全性前置胎盘合并胎盘植入剖宫产手术中的应用[J].临床麻醉学杂志, 2014, 30 (6) :571-573. [11]廖轶尼, 应豪.凶险型前置胎盘合并死胎及致死性胎儿畸形的处理[J].中国实用妇科与产科杂志, 2014, 30 (12) :939-940. [12]白耀武, 杨俊红.凶险性前置胎盘围手术期的麻醉管理[J].河北医药, 2014, 36 (14) :2125-2127. [13]陈淑萍.凶险型前置胎盘剖宫产术的麻醉处理分析[J].现代实用医学, 2014, 26 (6) :664-665. [14]史成梅, 贾东林, 李民, 等.穿透性胎盘植入合并凶险型前置胎盘孕妇行剖宫产的麻醉管理 (附1例报告) [J].中国微创外科杂志, 2015, 15 (8) :763-765. [15]韩丽莹.罗哌卡因腰麻用于剖宫产术患者的药效学及安全性[D].郑州:郑州大学, 2013.
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