饱胃急诊剖宫产患者行腰硬联合麻醉的危险因素分析

The risk factors of combined spinal and epidural anesthesia for pregnant women with full stomach in emergency cesarean section

目的分析饱胃患者急诊剖宫产行腰硬联合麻醉（CSEA）的危险因素。方法选择2010年1月至2012年1月在广州医学院第三附属医院在CSEA下行ASAI-Ⅱ级剖宫产手术的220例患者病例进行研究，其中饱胃急诊剖宫产136例为饱胃组，择期剖宫产84例为对照组。两组患者均采用CSEA。对饱胃组患者术中恶心、呕吐的相关因素进行偏相关分析，然后剔除两组术中使用卡前列素氨丁三醇注射液的病例后，再对术中不良事件和新生儿出生情况参数进行比较。结果饱胃组患者中，与恶心存在偏相关关系的因素是术中使用卡前列素氨丁三醇注射液（r=0．440）和术中发生低血压（r=0．274）；与呕吐存在偏相关关系的因素是术中使用卡前列素氨丁三醇注射液（r=0．646）。饱胃组与对照组在剔除使用卡前列素氨丁三醇注射液的病例后比较，对照组术中低血压的发生率高于饱胃组（X2=20．455，P〈0．05），两组其余指标的差异无统计学意义（P〉0．05）。结论术中使用卡前列素氨丁三醇注射液与低血压是饱胃患者在CSEA下行急诊剖宫产麻醉的危险因素。

Objective To analyze the risk factors of combined spinal and epidural anesthesia （CSEA） for pregnant women with full stomach in emergency cesarean section. Methods A retrospective study was conducted in 220 pregnant women undergoing ASA Ⅰ - Ⅱ cesarean section with CSEA, including 136 cases under emergent cesarean section with full stomach （full stomach group） and 84 cases under elective cesarean section （control group）, who were admitted to the Third Affiliated Hospital of Guangzhou Medial University from January 2010 to January 2012. Partial correlation analysis was used for risk factors of pregnancy women with full stomach, such as nausea, vomiting, and so on. After excluded the cases of using hemabate, adverse effects in cesarean section and the outcomes of the newborns were compared in the two groups. Results In full stomach group, nausea partial correlated with using hemabate （ r = 0. 440） and hypotensive during operation （ r = 0. 274 ）. And vomiting partial correlated with using hemabate （ r = 0. 646）. Compared in full stomach group and control group, the incidence rate of intraoperative hypotension was higher in control group than in full stomach group, excluded the cases of using hemabate, （ Z2 =20. 455 ,P〈0. 05）. But there were no significantly difference in the comparison of the other riskfactors（ P 〉 O. 05 ）. Conclusion Using hemabate during cesarean section and hypotension were the main risk factors of pregnant women with full stomach, who underwent emergent cesarean section with CSEA.