不同麻醉方式对前置胎盘行剖宫产患者血流动力学指标的影响

Effects of different anesthesia methods on hemodynamics of patients with placenta previa undergoing cesarean section

目的分析不同麻醉方式对前置胎盘行剖宫产患者血流动力学指标的影响。方法选取2018年3月至2019年8月青海仁济医院行剖宫产的96例前置胎盘患者作为研究对象。按照麻醉方式的不同分为全身麻醉组(n=42例)和硬膜外麻醉组(n=54例)。两组分别行全身麻醉和硬膜外麻醉,比较两组基线资料、术中情况及血流动力学指标。结果两组平均年龄、孕周、孕次、中央型前置胎盘比例及合并胎盘粘连、植入比例等基线资料比较,差异无统计学意义(P>0.05)。硬膜外麻醉组手术用时、术中失血量、术中输血量及术中输液量均少于全身麻醉组,升压药使用率、失血性休克发生率均低于全身麻醉组,差异具有统计学意义(P<0.05)。两组气管插管即刻(T1)、胎儿娩出时(T2)时收缩压(SBP)、收缩压(DBP)与麻醉诱导前(T0)相比均有下降,心率(HR)与T0相比增高,差异具有统计学意义(P<0.05);而术毕(T3)时SBP、DBP与T0比较,差异无统计学意义(P>0.05),HR与T0相比增高,差异具有统计学意义(P<0.05);硬膜外麻醉组T1、T2时SBP、DBP均高于全身麻醉组,HR低于全身麻醉组,差异具有统计学意义(P<0.05)。结论硬膜外麻醉应用于前置胎盘患者剖宫产中的效果稍优于全身麻醉,可减少对术中血流动力学的影响,降低术中失血量及术中输血量,且有助于预防失血性休克的发生。

Objective To analyze the effects of different anesthesia methods on hemodynamics of patients with placenta previa undergoing cesarean section.Methods 96 patients with placenta previa who underwent cesar-ean section in Qinghai Renji Hospital from March 2018 to August 2019 were selected,and divided into general anes-thesia group(n=42)and epidural anesthesia group(n=54)according to the different methods of anesthesia.The two groups received general anesthesia and epidural anesthesia,respectively.Baseline data,intraoperative condi-tions and hemodynamic indexes of the two groups were compared.Results There were no significant differences in baseline data between the two groups,such as average age,gestational age,gestational number,proportion of cen-tral placenta previa,and proportion of combined placenta adhesion and implantation(P>0.05).The operative time,intraoperative blood loss,intraoperative blood transfusion volume and intraoperative fluid infusion volume in epidural anesthesia group were less than those in general anesthesia group,and the utilization rate of hypertensive drugs and the incidence of hemorrhagic shock were lower than those in general anesthesia group(P<0.05).Systol-ic blood pressure(SBP)and systolic blood pressure(DBP)immediately after endotracheal intubation(T1)and at the time of delivery(T2)were decreased compared with those before anesthesia induction(T0),and heart rate(HR)was increased compared with T0(P<0.05).At the end of T3,SBP,DBP and T0 showed no statistically significant differences(P>0.05),while HR increased compared with T0(P<0.05).At T1 and T2,SBP and DBP of epidural anesthesia group were higher than those of general anesthesia group,while HR of epidural anesthe-sia group was lower than that of general anesthesia group(P<0.05).Conclusions The effect of epidural anesthe-sia in cesarean section of patients with placenta previa is slightly better than that of general anesthesia,which can reduce the influence on intraoperative hemodynamics,reduce the amount of intraoperative blood loss and blood transfusion,and help to prevent the occurrence of hemorrhagic shock.