广西141家医院产科椎管内麻醉并发神经损伤的调查分析

Investigation and analysis of the neurological injury after obstetric neuraxial anesthesia in 141 hospitals of Guangxi province

目的调查分析广西各级医院麻醉科2013~2017年产科椎管内麻醉神经损伤的发病率和治愈率。方法采用横断面调查方法,应用金数据进行调查问卷(表单)设计和数据收集,由广西临床麻醉学科质量控制中心向广西壮族自治区各级医院麻醉科质控员发放调查问卷,收集各医院产科和非产科椎管内麻醉后神经损伤病例的相关资料。结果共有141家医院完成调查问卷,5年内施行椎管内麻醉共1 055 504例,其中产科520 563例(49.3%);共有816例发生椎管内麻醉后神经损伤(总发病率为7.73■)。产科椎管内麻醉后神经损伤的总发病率、短暂神经综合征、脊神经根损伤和马尾综合征的发病率显著高于非产科椎管内麻醉(11.37■vs 4.24■, 9.55■vs 2.95■, 1.63■vs 0.77■, 0.08■vs 0,P<0.05)。单次腰麻后神经损伤的发病率(27.7■)显著高于硬膜外麻醉(9.1■)和腰硬联合麻醉(11.6■)。产科椎管内麻醉后神经损伤的治愈率为99%,短暂神经综合征治愈率最高(100%),其余类型的神经损伤治愈率不同,遗留有不同程度神经损伤症状。10例产科椎管内麻醉后神经损伤引起医疗纠纷,5例判为医疗伤害赔偿。结论产科椎管内麻醉后神经损伤的发病率明显高于非产科椎管内麻醉,绝大多数(99%)产科椎管内麻醉后神经损伤可以治愈,1%造成神经永久性损伤。

Objective To investigate and analyze the incidence and cure rate of neurologic injury after obstetric neuraxial anestheisa in 141 hospitals at all levels of Guangxi province, from 2013 to 2017. Methods A cross-sectional survey was conducted. The questionnaire was designed and data was collected through the gold data online system. The questionnaire was sent to the anesthetic quality control officers of hospitals at all levels in Guangxi Zhuang Autonomous Region by Guangxi clinical anesthesiology quality control center. Results A total of 141 hospitals completed questionnaires, and 1 055 504 cases received neuraxial anesthesia within five years, including 520 563 cases(49.3%) in the department of obstetrics, among which 816 cases had neurological injuries after neuraxial anesthesia(the total incidence rate was 7.73■). The total incidence of neurologic injury, the incidence of transient neurological syndrome, spinal nerve root injury and cauda equina syndrome were significantly higher in patients receiving obstetric neuraxial anesthesia than for non-obstetric patients(11.37■ vs 4.24■, 9.55■ vs 2.95■, 1.63■ vs 0.77■, 0.08■ vs 0, P<0.05). The incidence(27.7■) of neurologic injury after single spinal anesthesia was significantly higher than that of epidural anesthesia(9.1■) and combined spinal epidural anesthesia(11.6■). The cure rate of neurologic injury after obstetric neuraxial anesthesia was 99%. The cure rate of transient nerve syndrome was the highest(100%). The cure rates of other types of neurologic injury were different. There were 10 cases of medical disputes caused by neurologic injury after obstetric neuraxial anesthesia, and 5 cases were judged as medical injury compensation. Conclusion The incidence rate of neurologic injury after obstetric neuraxial anesthesia is obviously higher than that for non-obstetric. The vast majority(99%) of obstetric nerve injury after neuraxial anesthesia can be cured, only 1% cases cause permanent nerve injury.