剖宫产术产妇应用CSEA发生神经损伤的相关因素分析

Risk factors of nerve injury in combined spinal-epidural block anesthesia in women with cesarean section

目的探讨剖宫产术产妇应用腰麻与硬膜外联合阻滞(CSEA)发生神经损伤的相关因素。方法将2015年10月1日至2016年9月30日浙江省建德市妇幼保健院收治540例CSEA下行剖宫产术产妇作为研究对象,根据产妇的产程是否异常,分为实验组(产程异常)和对照组(非产程异常),分别为85例和455例。比较两组产妇术后神经损伤的发生率,应用Logistic逐步回归法进行多因素分析。结果 540例产妇中有13例发生神经损伤,对照组产妇神经损伤的发生率为1.76%(8/455),实验组产妇神经损伤的发生率为5.88%(5/85),对照组神经损伤的发生率明显低于实验组,差异具有统计学意义(χ~2=5.19,P=0.02)。多因素Logistic回归分析显示,产程异常是CSEA下剖宫产术产妇发生神经损伤的危险因素(OR=6.294,95%CI:2.202~17.384,P<0.001)。结论产妇产程异常与神经损伤有一定相关性。

Objective To investigate the related factors of nerve injury in women undergoing cesarean section with combined spinal-epidural anesthesia（ CSEA）. Methods Altogether 540 cases of cesarean section with CSEA hospitalized in Jiande Maternal and Child Health Care Hospital were selected as study subjects. Based on whether labor process was normal,85 cases were grouped into experimental group（ abnormal process） and 455 cases in control group（ normal process）. Incidence of postoperative nerve injury in two groups was compared and multiple factor analysis with Logistic stepwise regression method was implemented. Results Thirteen cases in 540 pregnant women had nerve injury. Incidence of nerve injury in the control group was 1. 76%（ 8/455）,and that in the experimental group was 5. 88%（ 5/85）.That in the control group was significantly lower than in the experimental group with statistical significance（ χ~2 = 5. 19,P = 0. 02）.Multiple factor Logistic regression analysis showed that birth process abnormalities was risk factor for occurrence of neural injury in cesarean section under CSEA（ OR = 6. 294; 95% CI： 2. 202-17. 384,P 0. 001）. Conclusion Abnormal labor process has correlation with nerve injury in pregnant women with cesarean section under CSEA.