再次剖宫产术中出血与麻醉因素的相关性分析

Analysis on Correlation Between Intraoperative Hemorrhage and Anesthesia Factors during Repeat Cesarean Section

目的:分析再次剖宫产术中出血与麻醉因素的相关性,为优化麻醉管理方案提供研究依据。方法:选取1192例再次剖宫产产妇作为研究对象,根据术中出血量将其分为研究组(术中出血量≥500 m L)和对照组(术中出血量<500 m L)。对两组产妇术中出血的一般因素和手术麻醉因素进行对比和分析。结果:有106例产妇术中出血量≥500 m L,发生率为8.89%,研究组产妇具有流产史比例、产前贫血比例、前置胎盘比例、胎盘粘连比例、胎盘植入比例、宫缩乏力比例高于对照组,孕程短于对照组,差异均有统计学意义(P<0.05)。研究组产妇的手术时间、子宫切除或部分切除比例、美国麻醉医师协会(ASA)ⅡⅢ级比例、罗哌卡因用量>15 mg比例高于对照组,差异均有统计学意义(P<0.05)。Logistic多元回归分析结果显示,再次剖宫产产妇术中出血的发生与前置胎盘、胎盘植入、宫缩乏力、子宫切除或部分切除及ASA分级具有相关性(P<0.05)。结论:再次剖宫产术中出血风险不仅与胎盘、子宫因素有关,而且受手术和麻醉因素的影响,临床医生应对产妇进行全面和准确的术前评估,优化麻醉管理方案和手术策略,从而减少术中出血的发生,确保手术的安全性。

Objective: To analyze the correlation between intraoperative hemorrhage and anesthesia factors during the repeat cesarean section to provide research basis for optimizing anesthesia management program. Methods: A total of 1192 parturient women,who underwent caesarean section again, were selected and divided into study group(the amount of intraoperative hemorrhage≥ 500 m L)and control group(the amount of intraoperative hemorrhage <500 m L) according to the amount of intraoperative hemorrhage. The general factors and anesthesia factors related to intraoperative hemorrhage between the two groups of parturient women were compared and analyzed. Results: The amount of intraoperative hemorrhage of 106 cases ≥500 m L, the incidence was 8.89%. The proportion of abortion history, the proportion of prenatal anemia, the proportion of placenta previa, the proportion of placenta adhesion, the proportion of placenta implantation, the proportion of uterine atony of the parturient women in the study group were higher than those in the control group, and the pregnancy process was shorter than that in the control group, the differences were statistically significant(P<0.05). The time of operation, the proportion of hysterectomy or partial hysterectomy, the proportion of ASA Ⅱ ~ Ⅲ grade and the proportion of ropivacaine dosage > 15 mg of the parturient women in the study group were significantly higher than those in the control group, the differences were statistically significant(P<0.05). The results of logistic multiple regression analysis showed that the occurrence of intraoperative hemorrhage during the repeat cesarean section was correlated with placenta previa, placenta implantation, uterine atony, hysterectomy or partial resection and ASA grade(P<0.05). Conclusions: The risk of intraoperative hemorrhage during the repeat cesarean section is not only related to placental and uterine factors, but also affected by operation and anesthesia factors. The clinician should make a comprehensive and accurate preoperative evaluation on the parturient women, optimize anesthesia management plan and operation strategy, so as to reduce the occurrence of intraoperative hemorrhage and ensure the safety of operation.