椎管内麻醉与全身麻醉用于妊娠合并血小板减少症产妇剖宫产术的临床价值研究

Clinical Value of Intraspinal Anesthesia and General Anesthesia for Cesarean Section of Pregnant Women with Thrombocytopenia

目的 探讨椎管内麻醉与全身麻醉用于妊娠合并血小板减少症产妇剖宫产术的临床价值研究。方法 将2019年1月-2021年12月在广东省梅州市妇幼保健院行剖宫产术分娩的80例妊娠合并血小板减少症产妇随机分为两组,每组各40例,对照组使用椎管内麻醉,观察组使用全身麻醉,对比两组的术中血流动力学指标、脐动脉及脐静脉血气分析指标、各项手术指标、新生儿指标、产妇并发症。结果 观察组麻醉5min的MAP高于对照组,而麻醉后5min、10min的HR低于对照组(P<0.05);观察组麻醉后脐动脉、脐静脉的PaO_(2)明显高于对照组,PaCO_(2)明显低于对照组(P<0.05),但两组pH值相当(P>0.05);两组手术时间、术中出血量、术前PLT水平相当(P>0.05),但观察组切皮至胎儿娩出时间更短,术后PLT水平高于对照组(P<0.05);观察组新生儿1min、5min的Apger评分、新生儿窒息率均与对照组相当(P>0.05);两组均有恶心呕吐病例,但无呼吸抑制、下肢活动受限等不良反应发生(P>0.05)。结论 全身麻醉用于妊娠合并血小板减少症产妇剖宫产术的临床价值更高,术中血流动力学稳定,脐动脉及脐静脉血气分析结果更好,且对新生儿无明显影响,而椎管内麻醉有严格适应证,仅适用于PLT>50×10^(9)/L的产妇。

Objective To investigate clinical value of intraspinal anesthesia and general anesthesia for cesarean section of pregnant women with thrombocytopenia.Methods The paper chose 80 pregnant women with thrombocytopenia with cesarean section at Meizhou City Maternal and Child Health Hospital Of Guangdong from January 2019 to December 2021,and divided them into two groups randomly,with 40 cases in each group.Control group was treated with intraspinal anesthesia,while observation group with general anesthesia.Intraoperative hemodynamic indexes,umbilical artery and vein blood gas analysis indexes,various surgical indexes,neonatal indexes,and maternal complications were compared between two groups.Results MAP of observation group after 5 minutes of anesthesia was higher than control group,while HR of observation group after 5 and 10 minutes of anesthesia was lower than control group(P<0.05).After anesthesia,PaO_(2) in umbilical artery and vein in observation group was significantly higher than control group,and PaCO_(2) was significantly lower than control group(P<0.05);operation time,intraoperative bleeding,and preoperative PLT levels in two groups were similar(P>0.05),but observation group had shorter time from skin incision to fetal delivery,and postoperative PLT level was higher than control group(P<0.05).Apger scores and neonatal asphyxia rate in observation group were comparable to control group at 1 and 5 min(P>0.05).There were cases of nausea and vomiting in both groups,but no adverse reactions including respiratory depression and lower limb movement limitation occurred(P>0.05).Conclusion General anesthesia can achieve high clinical value for cesarean section of pregnant women with thrombocytopenia,with stable hemodynamics,good blood gas analysis results of umbilical artery and vein,with no significant effect on neonates.Intraspinal anesthesia has strict indications,which is only suitable for PLT>50×10^(9)/L of pregnant women.