先兆子痫与子痫患者在剖宫产术中的麻醉处理与急救措施

Cesarean operation anesthesia treatment and first aid measures for preeclampsia and eclampsia patients

目的探讨先兆子痫与子痫患者剖宫产手术中的麻醉处理与急救措施。方法回顾性分析浙江省绍兴市上虞人民医院2014年3月至2015年9月收治的80例先兆子痫与子痫患者同时拟行剖宫产手术患者的临床资料,按照不同麻醉方法分为A组（16例,椎管内联合麻醉）、B组（17例,硬膜外麻醉）、C组（15例,丙泊酚静脉麻醉加硬膜外麻醉）、D组（16例,气管插管全麻）、E组（16例,气管插管全麻加硬膜外麻醉）,比较各组麻醉前后收缩压（SBP）、舒张压（DBP）及新生儿出生后Apgar评分。结果 5组患者T_0、T_1、T_2期间SBP有显著性差异,E组患者均最高（F值分别为4.58、3.74、3.15,均P〈0.05）,而各组T_3、T_4、T_5、T_6期间SBP均无显著性差异（F值分别为1.14、0.96、0.87、0.89,均P〉0.05）。5组患者T_0、T_1、T_2期间DBP有显著性差异,E组患者均最高（F值分别为4.24、3.96、2.27,均P〈0.05）,而各组T_3、T_4、T_5、T_6期间DBP均无显著性差异（F值分别为1.27、1.04、0.93、0.78,均P〉0.05）。经Fisher精确检验发现,各组的Apgar评分有显著性差异（P〈0.05）,A组新生儿Apgar评分8~10分所占比例最高（68.8%）。结论对出现抽搐、躁动、返流、误吸、呼吸困难、气道梗阻以及凝血障碍的患者应选择气管插管全麻或全麻加硬膜外麻醉的方法,椎管内麻醉新生儿Apgar评分较高,但需进一步大数据研究。

Objective To explore anesthesia treatment and first aid measures in cesarean operation for preeclampsia and eclampsia patients. Methods Retrospective analysis was conducted on clinical data of 80 cases of preeclampsia and eclampsia planning to perform cesarean section surgery in Shangyu People ＇s Hospital of Shaoxing City in Zhejiang Province from March 2014 to September 2015.According to different anesthetic methods, patients were divided into five groups, group A（ 16 cases, combined spinal epidural anesthesia）,group B（ 17 cases,epidural anesthesia）,group C（ 15 cases,propofol intravenous anesthesia combined with epidural anesthesia）,group D（ 16 cases,general anesthesia with endotracheal intubation） and group E（ 16 cases,endotracheal intubation general anesthesia combined with epidural anesthesia）. Systolic blood pressure（ SBP）,diastolic blood pressure（ DBP） before and after anesthesia and neonatal Apgar score after birth were compared among different groups. Results There was significant difference in SBP of T_0,T_1 and T_2period among 5 groups,and patients in group E had highest SBP value（ F value was 4. 58,3. 74 and 3. 15,respectively,all P〈 0. 05）,but there was no significant difference in SBP of T_3,T_4,T_5 and T_6period among 5 groups（ F value was 1. 14,0. 96,0. 87 and0. 89,respectively,all P〉 0. 05）. There was significant difference in DBP of T_0,T_1 and T_2period among 5 groups. Patients in group E had highest DBP value（ F was 4. 24,3. 96 and 2. 27,respectively,all P 〈0. 05）,but there was no significant difference in DBP of T3,T4,T5 and T6period among 5 groups（ F was 1. 27,1. 04,0. 93 and 0. 78,respectively,all P〉 0. 05）. Based on results of Fisher＇s exact test Apgar score had significant difference among different groups（ P〈 0. 05）. Neonatal Apgar score of group A had the highest proportion of 8- 10 score（ 68. 8%）. Conclusion For patients with convulsion,restlessness,reflux,aspiration,dyspnea,airway obstruction and coagulation disorder,endotracheal intubation general anesthesia or general anesthesia combined with epidural anesthesia should be chosen. Neonatal Apgar score of patients with combined spinal epidural anesthesia is higher,but further big data research is needed.