高龄妊娠合并血小板减少症剖宫产术不同麻醉方法的临床分析

Clinical analysis of different anesthetic methods in cesarean section of older pregnancy complicating thrombocytopenia

目的探讨不同麻醉方法用于高龄妊娠合并血小板减少症产妇剖宫产术的可行性及安全性。方法将2016年2月至2017年2月该院收治的行剖宫产手术的85例高龄妊娠合并血小板减少症产妇采用随机数字表法分为连续硬膜外麻醉组(28例)、连续蛛网膜下腔麻醉组(30例)和全身麻醉组(27例)。比较三组产妇平均动脉压(MAP)、心率、出血量、血小板计数、新生儿Apgar评分及不良反应发生情况等。结果连续蛛网膜下腔麻醉组产妇麻醉后5 min时MAP均明显低于连续硬膜外麻醉组和全身麻醉组;连续硬膜外麻醉组产妇麻醉后5、10 min时心率均明显高于连续蛛网膜下腔麻醉组和全身麻醉组,差异均有统计学意义(P<0.05);三组产妇术中出血量、血小板计数,新生儿Apgar评分比较,差异均无统计学意义(P>0.05);三组产妇均出现恶心、呕吐等不良反应。结论连续硬膜外麻醉、连续蛛网膜下腔麻醉和全身麻醉均可用于高龄妊娠合并血小板减少症产妇剖宫产术,但应注意不良反应的发生。

Objective To discuss the feasibility and safety of different anesthetic methods used in cesarean section of older pregnancy complicating thrombocytopenia. Methods Eighty-five cases of older pregnancy complicating thrombocytopenia in this hospital from February 2016 to February 2017 were randomly divided into the continuous epidural anesthesia group（28 cases）,continuous subarachnoid space anesthesia group（30 cases） and general anesthesia group（27 cases） by adopting the random number table method. The mean arterial pressure（MAP）,heart rate（HR）,amount of bleeding,platelet count,Apgar score of newborn and adverse reaction occurrence were compared among the three groups. Results MAP at 5 min after anesthesia in the continuous subarachnoid space anesthesia group was significantly lower than that in the continuous epidural anesthesia group and general anesthesia group（P〈0.05）;HR at 5,10 min after anesthesia in the continuous epidural anesthesia group was significantly higher than that in the continuous subarachnoid space anesthesia group and general anesthesia group,the difference was statistically significant（P〈0.05）;the amount of intraoperative bleeding,platelet count and Apgar score of newborn had no statistically significant difference among the three groups（P〈0.05）;the three groups all appeared the adverse reactions such as nausea and vomiting. Conclusion Continuous epidural anesthesia,subarachnoid space anesthesia and general anesthesia all can be used in cesarean section of older pregnancy complicating thrombocytopenia,but the occurrence of adverse reactions must be noted.