椎管内麻醉与全身麻醉用于合并血小板减少症产妇剖宫产术的临床观察

Clinical observation of intraspinal anesthesia and general anesthesia used in C-section of pregnant women with thrombopenia

目的为保障妊娠合并血小板减少症产妇及新生儿的安全，寻求剖宫产中有效的麻醉方法及管理。方法选择血小板计数（Ph）〈100×10^9的55例产妇，分椎管内麻醉组39例（Ph〉50×10^9／L）和全麻组16例（Ph〈50×10^9／L）。其中椎管内麻醉组中连续硬膜外15例（Ph〉70×10^9／L）、蛛网膜下腔麻醉24例（Pit为50×10^9-70×10^9/L），回顾性分析55例妊娠合并血小板减少症产妇在剖宫产术中的麻醉情况。结果所有妊娠合并血小板减少症产妇剖宫产术后均未出现并发症：椎管内麻醉产妇和全麻产妇术中出血量比较．差异无统计学意义（P〉0．05）；对产后1min新生儿进行Apgar评分，椎管内麻醉组的窒息新生儿发生率明显少于全麻组，差异有统计学意义（X^2=8．74，P〈0．05），而无窒息和轻度窒息新生儿发生率两组比较，差异均无统计学意义（X^2分别=2．25、2．89、P均〉0．05）。产后5min新生儿间的Apgar评分比较，差异无统计学意义（X^2分别=0．96、1.33、0．58，P均〉0．05）。结论妊娠合并血小板减少症产妇应根据实际情况合理选择麻醉方式，且应充分估计病情及术前准备。

Objective To explore the effective way of anaesthesia in C-sect and protect the newborn and pregnant women with thrombopenia. Methods Anaesthesia methods of 55 pregnant women with thrombopenia undergoing C-sect were analyzed. Results There was no complications happened. No statistic significance was found in the volume of blood loss between the women undergoing intraspinal anesthesia and general anesthesia（P〉0.05）. According to the Apgar score of newborn 1 min after delivery, the eases of newborn with apnea was much less in women undergoing intraspinal anesthesia than that in women undergoing general anesthesia （X^2=8.74,P〈0.05）. There was no statistic significance in the incidence of no neonatal asphyxia and mild asphyxia between two groups （ X^2= 2.25,2.89, P 〉 0.05）, There was no statistic significance in the Apgar score of newborn 5 min after delivery （X^2= 0.96,1.33,0.58, P〉0.05）. Conclusions The way of anaesthesia in C-sect of pregnant women with thrombopenia should be chosen according to the clinical situation and preoperative preparation.