重度子痫前期患者行剖宫产术的麻醉方式选择

The Anesthesia Mode of Cesarean Section in Patients with Severe Preeclampsia

目的探究合并重度子痫前期行剖宫产术患者的麻醉方式。方法回顾性分析2013年6月至2016年6月在华中科技大学同济医学院附属协和医院行剖宫产术的重度子痫前期患者,麻醉方式为椎管内麻醉或全身麻醉,比较两组的临床特征、术中血压及新生儿转归。结果330例患者中椎管内麻醉279例,全麻51例。术前血小板数量全麻组显著低于椎管内麻醉组。两组患者术中血压差异无统计学意义,低血压的发生率分别为18.3%、9.8%,差异无统计学意义。术毕转入重症监护室的比例,椎管内麻醉组(1.4%)显著低于全麻组(15.7%)。新生儿1 min Apgar评分、5 min Apgar评分椎管内麻醉组均高于全麻组,差异有统计学意义。新生儿窒息的发生率分别为16.8%、35.3%,全麻增加新生儿需要面罩给氧的风险,是新生儿窒息的危险因素。结论椎管内麻醉可作为重度子痫前期患者行剖宫产术的首选麻醉方式。合并血小板减少、凝血功能障碍的重度子痫前期患者,需权衡风险。若选择行全麻剖宫产,则需做好新生儿抢救复苏的准备。

Objective To explore the anesthesia mode of cesarean section in patients with severe preeclampsia.Methods A retrospective analysis of severe pre-eclampsia patients who underwent cesarean section(from June 2013 to June 2016)was conducted.The anesthesia mode was intravertebral anesthesia or general anesthesia.The clinical features,intraoperative blood pressure and neonatal outcome were compared.Results A total of 330 cases were included in this study.Among them,279 cases received intravertebral anesthesia,and the other 51 cases underwent general anesthesia.Preoperative platelet number in the general anesthesia group was significantly lower than that in the intravertebral anesthesia group.There was no significant difference in intraoperative blood pressure.The incidence of hypotension was 18.3%and 9.8%,with no statistically significant difference.The proportion of patients transferred to ICU in the intravertebral anesthesia group(1.4%)was significantly lower than that in the general anesthesia group(15.7%).Neonatal 1 min Apgar and 5 min Apgar were significantly lower in the general anesthesia group than in the intravertebral anesthesia group.The incidence of neonatal asphyxia was 16.8%and 35.3%,respectively.General anesthesia increased the risk of mask-assisted ventilation,which is a risk factor for neonatal asphyxia.Conclusion Intravertebral anesthesia may be the preferred method for cesarean section in patients with severe preeclampsia.For patients with thrombocytopenia and coagulation dysfunction,risks should be weighed.If choosing general anesthesia,resuscitation of neonate should be prepared.