胎盘植入患者行剖宫产术的麻醉管理

Anesthetic management of patients with placenta implantation undergoing cesarean section

收集2012年至2016年出院诊断包含“胎盘植入、剖宫产”的本院首诊患者的病例资料，包括患者胎盘植入类型、麻醉方式、术中出血量、腹主动脉球囊置人情况、子宫切除情况、术毕转入ICU情况和术后住院时间，总结胎盘植入患者行剖宫产术的麻醉管理经验。共纳入156例患者，其中粘连型70例（44．9％）、植入型50例（32．1％）、穿透型36例（23．1％）；3种类型术中失血量分别为（624±451）ml、（2100±1283）m1、（5281±3114）ml；椎管内麻醉比率分别为92％、62％、14％；椎管内麻醉复合全身麻醉比率分别为4％、20％、61％；全身麻醉比率分别为4％、18％、25％。14例患者术中置人腹主动脉球囊，其中植入型3例，穿透型11例。49例患者术毕转入ICU，其中粘连型1例，植入型16例，穿透型32例。胎盘植入患者行剖宫产术应重视术前访视与评估，积极参与多科室协作，根据病情制定麻醉方案，术中严密监测生命体征，关注手术进程与出血量，合理输血输液，危重患者术后应转入ICU加强监护和治疗。

The medical records of firstly diagnosed patients with the discharge diagnosis contained ＂ placenta implantation, cesarean section＂ at Peking University Third Hospital from 2012 to 2016, were col-lected. The records included the type of placenta implantation, anesthetic methods, intraoperative blood loss, abdominal aorta balloon placement, hysterectomy, requirement for intensive care unit （ICU） ad-mission and length of hospital stay, and the anesthetic management experience was summarized in the pa-tients with placenta implantation undergoing cesarean section. A total of 156 patients were included in this study, and among the 156 patients, there were 70 cases of acereta （44. 9%）, 50 cases of inereta （32. 1%） and 36 cases of percreta （23.1%）. The intraoperative blood loss was （624±451） ml, （2 100± 1 283） ml and （5 281±3 114） ml, the ratio of neuraxial anesthesia was 92%, 62% and 14%, the ratio of neuraxial anesthesia combined with general anesthesia was 4%, 20% and 61%, and the ratio of general an-esthesia was 4%, 18% and 25% in the patients of aecreta, of increta and of percreta, respectively. The abdominal aorta balloon was placed during surgery in 14 cases, and among the 14 cases, there were 3 cases of increta and 11 cases of percreta. Forty-nine patients were transferred to ICU after operation, and among the 49 patients, there was 1 case of acereta, 16 cases of increta and 32 cases of percreta. Anesthesiologists should pay attention to the preoperative interview and assessment, actively try to work with multi-depart-ments, make anesthetic regimen according to patient＇s condition, closely monitor patient＇s vital signs dur-ing operation, concern about the operating process and blood loss, and ensure proper infusion and transfu-sion for the patients with placenta implantation undergoing cesarean section, and in addition, the critically ill patients should be transferred to ICU after operation for intensive monitoring and treatment.