超声引导下腹横平面阻滞联合全身麻醉用于前置胎盘剖宫产手术效果

Effect of ultrasound-guided transverse plane block combined with general anesthesia in cesarean section due to placenta previa

目的:探讨超声引导下腹横平面阻滞联合全身麻醉在前置胎盘剖宫产术的麻醉效果。方法:回顾收集2018年1月1日-2020年1月1日本院接受剖宫产治疗的前置胎盘产妇病历97例,根据麻醉方式不同分为全身麻醉组、椎管内麻醉组和神经阻滞复合全麻组,分析比较各组患者基本信息以及产前出血、麻醉方式、术后疼痛等情况。结果:平均输血量和血液回输量全身麻醉组高于椎管内麻醉组(P<0.05),但椎管内麻醉组与神经阻滞复合全麻组无差异(P>0.05);新生儿1min内Apgar评分<7的病例比率全身麻醉组最高(P<0.05);神经阻滞复合全麻组术中机械通气的时间最短,瑞芬太尼消耗量更低,全身麻醉组住院时间最长(P<0.05);静息和活动状态下全身麻醉组术后12h48h疼痛评分最高(P<0.05),神经阻滞复合全麻组术后48h疼痛评分较低(P<0.05)。结论:前置胎盘剖宫产手术,全身麻醉术中出血量多,对新生儿呼吸影响大,术后镇痛效果不佳;超声引导下腹横平面阻滞复合全身麻醉可降低手术出血量,降低对新生儿呼吸的影响,提高术后镇痛效果。

Objective:To study the anesthesia effect of ultrasound-guided transverse plane block combined with general anesthesia in cesarean section due to placenta previa.Methods:97 women with placenta previa who received cesarean section from January 1,2018 to January 1,2020 were collected retrospectively.According to the different anesthesia methods,these women were divided into group A(women with general anesthesia),group B(women with intraspinal anesthesia),and group C(women with nerve block combined general anesthesia).The basic information,prenatal bleeding volume,anesthesia method,and postoperative pain situation of the women were analyzed and compared among the three groups.Results:The average blood transfusion volume and self blood transfusion volume of the women in group A were the highest,and those of the women in group B were the lowest(P<0.05),but those of the women had no significant difference between group C and group A(P>0.05).The proportion of Apgar score<7 of newborns within 1 min after born in group A was the highest(P<0.05).The duration of mechanical ventilation of the women in group C was the shortest,and the consumption of remifentanil of the women in group C was the lowest.The hospitalization time of the women in group A was the longest(P<0.05).In resting or active state,the pain score at postoperative 12 h-48 hof the women in group A was the highest(P<0.05),while that at postoperative 48 hof the women in group C was significant lower(P<0.05).Conclusion:During cesarean section of women with placenta previa,general anesthesia may increase the amount of blood loss,influence on neonatal respiration,and has less postoperative analgesia effect.Ultrasound-guided lower abdominal transverse plane block combined with general anesthesia can reduce the amount of bleeding amount,reduce the adverse influence on neonatal respiration,and improve postoperative analgesia.