前置胎盘患者剖宫产术中的麻醉管理:一项回顾性队列研究

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前置胎盘患者剖宫产术中的麻醉管理:一项回顾性队列研究

贵州医科大学  麻醉与心脏电生理课题组

翻译：张中伟   编辑：张中伟  审核：曹莹

背景 

前置胎盘的发病率正在持续上升。我们认为剖宫产是前置胎盘产妇妊娠的唯一安全并合适的分娩方式。麻醉管理在剖宫产术中非常重要。本研究的目的是比较在剖宫产术中使用椎管内麻醉的前置胎盘产妇与使用全身麻醉的前置胎盘产妇的结局及新生儿的健康情况。

方法 

从2014年1月1日至2019年6月30日，在我们的大型学术机构对所有前置胎盘患者进行了回顾性队列研究。患者在剖宫产术中接受椎管内麻醉或全身麻醉。

结果   

本研究纳入了1234例确诊为前置胎盘的患者，并于本医疗机构接受剖宫产术。737例(59.7%)患者进行了椎管内麻醉，497例(40.3%)患者进行了全身麻醉。椎管内麻醉组的平均预计失血量为558.96±42.77毫升，明显低于全身麻醉组的预计失血量1952.51±180毫升(p < 0.001)。737名患者中有146名(19.8%)在椎管内麻醉时需要输血，而497名患者中有381名(76.7%)在全身麻醉时需要输血。椎管内麻醉下新生儿窒息率和NICU入院率明显低于全身麻醉(分别为2.7%对19.5%和18.2%对44.1%)。排除干扰因素后进行对比，椎管内麻醉组患者失血量较少，1分钟和5分钟的Apgar评分较高，输血率、新生儿窒息率和NICU入院率较低。

结论   

我们的数据表明，在剖宫产术中接受椎管内麻醉可以为前置胎盘产妇和新生儿带来更好的结局。

原始文献来源： Dazhi Fan, Jiaming Rao, Dongxin Lin, et al. Anesthetic management in cesarean delivery of women with placenta previa: a retrospective cohort study.[J]. BMC Anesthesiol (2021) 21:247 :1  

  英文原文     

Anesthetic management in cesarean

delivery of women with placenta previa:

a retrospective cohort study

Background: The incidence of placenta preiva is rising. Cesarean delivery is identified as the only safe and appropriate mode of delivery for pregnancies with placenta previa. Anesthesia is important during the cesarean delivery.

The aim of this study is to assess maternal and neonatal outcomes of patients with placenta previa managed with neuraxial anesthesia as compared to those who underwent general anesthesia during cesarean delivery.

Method:A retrospective cohort study was performed of all patients with placenta preiva at our large academic institution from January 1, 2014 to June 30, 2019. Patients were managed neuraxial anesthesia and general anesthesia during cesarean delivery.

Results:We identified 1234 patients with placenta previa who underwent cesarean delivery at our institution. Neuraxial anesthesia was performed in 737 (59.7%), and general anesthesia was completed in 497 (40.3%) patients. The mean estimated blood loss at neuraxial anesthesia of 558.96 ± 42.77 ml were significantly lower than the estimated blood loss at general anesthesia of 1952.51 ± 180 ml (p < 0.001). One hundred and forty-six of 737 (19.8%) patients required blood transfusion at neuraxial anesthesia, whereas 381 out of 497 (76.7%) patients required blood transfusion at general anesthesia. The rate neonatal asphyxia and admission to NICU at neuraxial anesthesia was significantly lower than general anesthesia (2.7% vs. 19.5 and 18.2% vs. 44.1%, respectively). After adjusting confounding factors, blood loss was less, Apgar score at 1- and 5-min were higher, and the rate of blood transfusion, neonatal asphyxia, and admission to NICU were lower in the neuraxial group.

Conclusion:Our data demonstrated that neuraxial anesthesia is associated with better maternal and neonatal outcomes during cesarean delivery in women with placenta previa.

END

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关键词:

previa,blood,剖宫产术,NICU,回顾性,新生儿,胎盘,患者,麻醉,前置,管理,椎管

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