不同类型胎盘植入产妇麻醉管理对母婴预后的影响

Effects of anesthesia management on maternal and neonatal prognosis in patients with different types of placenta implantation

目的研究不同类型胎盘植入产妇的麻醉管理对母婴预后的影响。方法收集诊断为“胎盘植入”的病例，剔除自然流产、人工流产及削宫取胎的病例，最终82例患者纳入到本研究中。根据胎盘植入程度分为黏连组（A组，41例）、植入组（I组，20例）、穿透组（P组，21例），分析产妇的麻醉管理及母婴预后。结果A组34例（82．9％）行椎管内麻醉，6例（14．6％）行全身麻醉，1例（2．4％）先行椎管内麻醉后术中转为全身麻醉；I组11例（55．0％）行椎管内麻醉，6例（30．0％）行全身麻醉，3例（15．0％）先行椎管内麻醉后术中转为全身麻醉；P组2例（9．5％）行椎管内麻醉，12例（57．1％）行全身麻醉，7例（33．3％）先行椎管内麻醉后术中转为全身麻醉。不同类型胎盘植入的麻醉方式选择差异有统计学意义（P〈0．05）。胎盘植入程度越重，出血量越多，产妇子宫切除率越高，新生儿1min Apgar评分越低，组问比较差异有统计学意义（P〈0．05）。结论胎盘植入程度轻者，首选椎管内麻醉，穿透型植入且术前预先放置腹主动脉球囊导管的产妇，首选全身麻醉。胎盘植入程度与新生儿1min Apgar评分及术中出血量密切相关。

Objective To investigate the effects of anesthesia management on maternal and neonatal prognosis in patients complicated with different types of placenta implantation. Methods A retrospective case review of the patients with placenta implantation from January 2009 to May 2017 at the department of Obstetrics in Peking University First Hospital was conducted. Patients with either natural or artificial abortion were excluded, and a total of 82 cases were enrolled into this study. According to the degree of placenta implantation, the cases were divided into 3 groups： accreta group（groupA, n=41）, increta group（group I, n=20）, and percreta group（group P, n=21）. We analyzed the anesthesia management, and maternal and neonatal prognosis. Results Anesthetic paradigms among three groups were significantly different（P〈0.05）. In the accreta group, 34 cases（82.9%） underwent spinal anesthesia, 6 cases（14.6%） underwent general anesthesia, and only 1 case（2.4%） was eventually switched to general anesthesia from initial spinal anesthesia （mixed anesthesia） during the operation. In the increta group, spinal, general, and mixed anesthesia were respectively performed in 11 （55.0%）, 6 cases （30.0%）, and 3 （15.0%） cases, in the percreta group, 2 （9.5%） , 12 （57.1%）, and 7 （33.3%） cases underwent spinal, general, and mixed anesthesia, correspondingly. Patients with greater degree of placental implantation bled more and had higher rates of hysterectomy, and their neonates exhibited lower Apgar score 1 min after birth. Conclusions Spinal anesthesia can be used as the first choice of cesarean section complicated with placenta accrete, while general anesthesia should be considered in placenta percreta, especially those carrying abdominal aortic balloon catheters.