摘要
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.
作者
曾鸿
王阳
容晓莹
郭向阳
Zeng Hong;Wang Yang;Rong Xiaoying;Guo Xiangyang(Department of Anesthesiology, Peking University, Third Hospital, Beijing 100191, China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2018年第2期192-195,共4页
Chinese Journal of Anesthesiology
关键词
胎盘植入
剖宫产术
麻醉
Placenta implantation
Cesarean section
Anesthesia