连续硬膜外麻醉与气管插管静脉全麻下宫内外合并妊娠腹腔镜手术患者的妊娠结局分析

Analysis of pregnancy outcomes in patients with heterotopic pregnancy combined with laparoscopic surgery under continuous epidural anesthesia and tracheal intubation intravenous anesthesia

目的比较罗哌卡因连续硬膜外麻醉与气管插管丙泊酚静脉全麻对宫内外合并妊娠(HP)腹腔镜手术患者妊娠结局的影响。方法回顾性分析2010年12月—2018年1月期间完成的70例宫内外合并妊娠腹腔镜手术的临床资料,根据麻醉方式不同分为气管插管丙泊酚静脉全麻组(A组,n=37)和罗哌卡因连续硬膜外麻醉组(B组,n=33)。记录两组患者的术前资料、术中情况、围术期不良事件情况、妊娠结局及新生儿情况。结果全部手术均顺利完成。(1)A组5例患者(13.5%)自然流产,32例患者(86.5%)继续妊娠直至分娩;B组4例患者(12.1%)自然流产,29例患者(87.9%)继续妊娠直至分娩;组间比较差异无统计学意义(P=1.000)。(2)A组2例患者早产(6.3%),B组2例患者早产(6.9%),组间比较差异无统计学意义(P=1.000)。(3)所有新生儿均无窒息,无出生缺陷,其中A组低体质量儿2名(6.3%),B组低体质量儿2名(6.9%),组间比较差异无统计学意义(P=1.000)。结论 HP患者在罗哌卡因连续硬膜外麻醉与气管插管丙泊酚静脉全麻两种麻醉方式下腹腔镜手术均可获得良好的妊娠结局。

Objective To compare the effects of continuous epidural anesthesia with ropivacaine and tracheal intubation intravenous anesthesia with propofol on pregnancy outcomes in patients with heterotopic pregnancy undergoing laparoscopic surgery. Methods Seventy patients with heterotopic pregnancy undergoing laparoscopic surgery from December 2010 to January 2018 were selected and divided into two groups according to the different ways of anesthesia. One group had tracheal intubation intravenous anesthesia with propofol （group A, n=37）, and the other group received continuous epidural anesthesia with ropivacaine （group B, n=33）. The preoperative data, intraoperative conditions, peri-operative adverse events, pregnancy outcomes and newborns status were recorded. Results All the operations were completed successfully. In group A, 5 patients （13.5%） had spontaneous abortion and 32 patients （86.5%） continued to be pregnant until childbirth. In group B, 4 patients （12.1%） had spontaneous abortion and 29 patients （87.9%） continued to be pregnant until childbirth. There was no significant difference between the two groups （P=1.000）. In group A, 2 patients had premature delivery （6.3%） and 2 patients in group B were premature （6.9%）, there was no significant difference between the two groups （P=1.000）. No asphyxia or congenital malformation was seen in all the newboms. There were 2 low weight neonates in group A （6.3%） and 2 low weight neonates in group B （6.90%）, there was no significant difference between the two groups （P=1.000）. Conclusion All patients with heterotopic pregnancy combined with laparoscopic surgery under continuous epidural anesthesia with ropivacaine and tracheal intubation intravenous anesthesia with propofol can achieve good pregnancy outcome.