58例腰硬联合阻滞分娩镇痛试产失败中转剖宫产病例的麻醉处理

Anesthesia for cesarean section after failed labor under combined spinal and epidural analgesia: analysis of 58 cases

目的总结腰硬联合阻滞分娩镇痛试产失败中转剖宫产麻醉实施的经验,为分娩镇痛中转剖宫产麻醉的有效安全实施提供参考。方法回顾性纳入2017年10月至2018年10月在华中科技大学同济医学院附属同济医院行腰硬联合阻滞分娩镇痛试产失败中转剖宫产的58例单胎妊娠产妇。所有产妇均行腰硬联合阻滞镇痛,决定中转剖宫产后,先于硬膜外给予0.125%罗哌卡因10ml,入手术室后给予1%利多卡因5ml作为试验量,观察5min后给予1%罗哌卡因10ml,罗哌卡因使用后超过10min未起效者为硬膜外麻醉失败,改用全身麻醉补救。回顾病例资料,描述性分析58例产妇的剖宫产麻醉实施方法、结果及母婴结局。结果58例产妇中,5.2%(3/58)直接实施全身麻醉;其余94.8%(55/58)实施硬膜外麻醉,其中3.6%(2/55)硬膜外麻醉失败后改全身麻醉,另外96.4%(53/55)硬膜外麻醉成功。硬膜外麻醉不良反应:15.1%(8/53)发生平均动脉压下降超过20%,5.7%(3/53)发生恶心呕吐。新生儿1minApgar评分0~3分者占1.7%(1/58)、4~7分者占17.2%(10/58)、8~10分者占81.0%(47/58)。5minApgar评分4~7分者占3.4%(2/58),均转新生儿科治疗;8~10分者占96.6%(56/58)。结论硬膜外分娩镇痛可基本安全有效地转换为剖宫产麻醉。

Objective To summarize the experience in anesthesia management for cesarean section(CS) after tailed labor in women with combined spinal and epidural analgesia and to provide evidence for more effective and safer clinical practice. Methods We included 58 singleton pregnant women who received spinal and epidural analgesia during labor but converted to CS at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from October 201 7 to October 201 8. When CS was indicated, 10 ml of 0.125% ropivacaine was given through the epidural catheter immediately, and 5 ml of 1% lidocaine was given when arriving at the operating room. Five minutes later. 10 ml of 1% ropivacaine was administered. General anesthesia would be required when epidural anesthesia was considered to be failed 10 min after the usage of ropivacaine. Clinical datas were retrospectively reviewed. The management and effects of anesthesia for CS. maternal and neonatal outcomes were described. Results Of the 58 patients when CS was indicated during labor. 5.2%(3/58) received general anesthesia immediately. Among the other 94.8%(55/58) who received epidural anesthesia. 3.6%(2/55) converted to general anesthesia later. Adverse effects of epidural anesthesia in eluded reduced mean artery pressure (8/53, 15.1%), nausea and vomiting (3/53. 5.7%). For the neonatal Apgar score at 1 min. one out of the 58 babies (1.7%) was between 0 and 3, ten (17.2%) between 4 and 7. and 47 (81.0%) between 8 and 10. The two babies (3.4%) with Apgar score between 4 and 7 at 5 min were both referred to the department of Neonatology, and the rest 56 neonates (96.6%) scored 8~10. Conclusions Spinal and epidural analgesia in labor can be safely and effectively adjusted to anesthesia tor CS.