2019冠状病毒病流行期间剖宫产术的麻醉处理

Anesthesia management for cesarean delivery during the corona virus disease 2019(COVID-19)pandemic

目的 回顾性分析2019冠状病毒病(C O V ID-19)流行期间剖宫产术的麻醉处理.方法 收集2020年1月23日至3月25日期间华中科技大学同济医学院附属武汉中心医院所有剖宫产的产妇相关资料,包括一般资料、合并症、临床表现、实验室资料、肺部CT影像、严重急性呼吸综合征冠状病毒2(SARS-CoV-2)咽拭子核酸及血清抗体检测结果、麻醉及手术相关数据、新生儿出生体重、Apgar评分、参与手术麻醉医师术后14天内的健康状态等.结果 共35例产妇纳入分析,剖宫产术后COVID-19确诊11例,疑似5例.11例确诊C O V ID-19患者中,仅4例出现发热等临床症状,且症状轻微.围术期所有疑似和确诊C O V ID-19病例均无重型或危重型肺炎发生.与COVID-19排除组相比,COVID-19疑似+确诊组患者术前血淋巴细胞计数低(F=18.576,P<0.05)、术前C-反应蛋白水平高(Z=2.977,P<0.05)、急性妊娠合并症胎膜早破或胎儿宫内窘迫发生率高(P=0.013).术中两组患者麻醉方式、麻醉后低血压发生率、术中失血、新生儿出生体重、5min Apgar评分差异均无统计学意义(均P>0.05).术后两组均未见麻醉相关并发症,观察期内未见参与手术的麻醉医师感染COVID-19.结论 在COVID-19疫区,急诊剖宫产产妇均应按疑似或确诊病例对待.在严密监护下,椎管内麻醉和全身麻醉均可安全用于C O V ID-19产妇剖宫产术.严格遵守感控流程、加强个人防护,能大大降低医务人员职业暴露的风险.

Objective To retrospectively analyze the anesthetic management of parturients undergoing cesarean delivery during the corona virus disease 2019(COVID-19)pandemic.Methods Consecutive parturients undergoing cesarean delivery in the Central Hospital of Wuhan from January 23,2020 to March 20,2020 were included.Their clinical data were collected retrospectively,including general characteristics,complication,clinical and laboratory characteristics,chest computed tomography scans,nucleic acid and serum antibody test results for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),anesthesia and surgery-related data,birth weight and Apgar score of the newborns,as well as the health status of the staff anesthesiologist over 14-day observation period.Results A total of 35 parturients were included in the analysis,with 11 confirmed cases and 5 suspected cases of COVID-19.Among the 11 COVID-19 confirmed cases,only 4 patients had mild to moderate fever and other symptoms.None of both confirmed and suspected COVID-19 cases developed severe or critical pneumonia.Compared to those without COVID-19,parturients with suspected or confirmed COVID-19 had lower lymphocyte count(F=18.576,P<0.05),higher level of C-reactive protein at admission(Z=2.977,P<0.05),and higher incidence of premature rupture of membrane or fetal distress as representative of acute pregnancy complications(P=0.013).There were no statistically significant differences in the anesthetic regimen,the incidence of post-anesthesia hypotension,intraoperative blood loss,birth weight and 5 min Apgar score of their newborns between these two groups of parturients.No anesthesia-related complication was observed after surgery,and no staff anesthesiologist was infected with COVID-19 throughout the observation period.Conclusion Parturient necessitating emergency cesarean delivery should be treated as a suspected or confirmed cases in the core epidemic area of COVID-19.Under close monitoring,both intrathecal anesthesia and general anesthesia can be safely administered for cesarean delivery in parturients with COVID-19.Strict adherence to infection control procedures,particularly appropriate use of personal protective equipment,can significantly reduce the risk of occupational exposure for medical personnel.