不同麻醉方式对凶险性前置胎盘剖宫产母婴结局的影响

Effects of different anesthesia methods on maternal and infant outcomes of cesarean section with pernicious placenta previa

目的通过回顾性病例数据分析,探讨不同麻醉方式对凶险性前置胎盘剖宫产母婴结局的影响。方法选择昆明医科大学附属延安医院2018年1月-2020年12月因凶险性前置胎盘行剖宫产的122例产妇,根据麻醉方式不同分为全身麻醉组(G组,n=94)和腰硬联合麻醉组(C组,n=28),分析比较2组产妇手术时间、术中失血量、输血量、术后是否转ICU、术后至出院时间和总住院时间,以及新生儿娩出后1、5 min Apgar评分情况。结果C组产妇手术时间、术后至出院时间和总住院时间明显短于G组,术中失血量、输血量和术后住ICU比率明显低于G组(P<0.05);新生儿1 min Apgar评分C组优于G组(P<0.05);2组5 min Apgar评分差异无统计学意义(P=0.80)。结论与全身麻醉相比,腰硬联合麻醉用于合并凶险性前置胎盘的剖宫产产妇,对于母婴更为安全,术后能更快康复出院,在无禁忌症的情况下,该类产妇行剖宫产术可优先选择腰硬联合麻醉。

Objective To explore the effects of different anesthesia methods on maternal and infant outcomes of cesarean section with pernicious placenta previa through the analysis of retrospective case data.Methods Total of 122 patients of cesarean section with pernicious placenta previa in Yan’an Hospital Affiliated to Kunming Medical University from January 2018 to December 2020 were selected and divided into general anesthesia group(group G,n=94)and combined spinal and epidural anesthesia(CSEA)group(Group C,n=28).The operating time length,intraoperative blood loss volume,blood transfusion volume,ICU transferring after operation,postoperative to discharge time,total hospital stays,and the Apgar score at 1 and 5 minutes after delivery were analyzed and compared between two groups.Results The operating time length,postoperative to discharge time and total hospital stay in C group were significant shorter than those in G group,and the intraoperative blood loss volume,volume of blood transfused and rate of transfer to ICU after operation in C group were significant lower than those in G group(P<0.05).The Apgar score at 1 minute after birth in group C was better than that in Group G(P<0.05),while there was no statistical significance in the difference at 5 minute’s Apgar score between the two groups(P=0.80).Conclusion Compare with general anesthesia,combined spinal and epidural anesthesia can provide better outcomes of patients undergoing cesarean section due to pernicious placenta previa.In the absence of contraindications,the combined spinal and epidural anesthesia is preferred for cesarean section.