麻醉因素对中重度肺动脉高压产妇剖宫产术预后的影响  

Effect of anesthesia factor on prognosis of cesarean section in parturients with medium and severe pulmonary arterial hypertension

作　　者：张延荣 代思思 高晓薇[1] 曹亚楠[1] 杨玥 张重[1] 王锷[1] Zhang Yanrong;Dai Sisi;Gao Xiaowei;Cao Yanan;Yang Yue;Zhang Zhong;Wang E(Department of Anesthesiology,Xiangya Hospital of Central South University. Changsha 410008,China)

机构地区：[1]中南大学湘雅医院麻醉手术部,长沙410008

出　　处：《中华麻醉学杂志》2019年第1期14-17,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金面上项目(81370251).

摘　　要：目的比较全麻与硬膜外麻醉对中重度肺动脉高压产妇剖宫产术预后的影响。方法选择2011年11月1日至2017年12月31日于本中心在全麻或硬膜外麻醉下行剖宫产术的中重度肺动脉高压产妇,孕周≥24周,年龄20~45岁,按照麻醉方式分为全麻组和硬膜外麻醉组。全麻为静吸复合麻醉。记录术后5 d内最高体温、术后3 d内最低SpO2(鼻导管吸氧2~4 L/min)、ICU停留时间、术后抗生素使用时间、肺动脉高压靶向药物的使用情况、实验室检查结果(血液生化、凝血功能)、术后机械通气情况、住院时间、住院费用;记录新生儿Apgar评分、体重,新生儿及产妇术后院内并发症及院内死亡情况。采用Cox回归分析筛选中重度肺动脉高压产妇剖宫产术预后的危险因素。结果本研究纳入57例产妇,全麻组21例,硬膜外麻醉组36例。与全麻组比较,硬膜外麻醉组术后机械通气率降低,产妇院内不良事件发生率和死亡率降低,术后白蛋白水平升高,部分凝血活酶时间缩短(P<0.05),其余指标差异无统计学意义(P>0.05)。Cox回归分析结果显示,麻醉方式和术前SpO2差是中重度肺动脉高压产妇剖宫产术不良事件和死亡的独立危险因素,全麻下行剖宫产的产妇不良事件发生风险和死亡风险高于椎管内麻醉(P<0.05)。结论与全麻比较,硬膜外麻醉下行剖宫产术的中重度肺动脉高压产妇预后较好。Objective To compare the effects of general anesthesia and spinal anesthesia on prognosis of cesarean section in parturients with medium and severe pulmonary arterial hypertension (PAH). MethodsParturients with medium and severe PAH, at ≥24 weeks of gestation, aged 20-45 yr, undergoing elective cesarean section under general or epidural anesthesia from November 1, 2011 to December 31, 2017 in our hospital, were divided into general anesthesia group and epidural anesthesia group according to the anesthetic method. General anesthesia was combined intravenous-inhalational anesthesia. The highest temperature within 5 days after surgery, the lowest SpO2 (inhaling oxygen 2-4 L/min via a nasal tube) within 3 days after surgery, duration of intensive care unit stay, time of postoperative use of antibiotics, requirement for targeted drugs for pulmonary hypertension, results of laboratory tests (blood biochemistry, coagulation function), postoperative mechanical ventilation, length of hospital stay, and hospitalization costs were recorded. The Apgar score and weight of the newborn, postoperative complications and death of the newborn and parturients in hospital were recorded. Cox regression analysis was used to identify the risk factors after cesarean section in parturients with medium and severe PAH. ResultsFifty-seven parturients were enrolled in this study, with 21 cases in general anesthesia group and 36 cases in epidural anesthesia group. Compared with general anesthesia group, the rate of postoperative mechanical ventilation was significantly decreased, the incidence of adverse events of parturients in hospital and mortality rate were decreased, the postoperative level of albumin was increased, activated partial thromboplastin time was shortened (P<0.05), and no significant change was found in the other parameters in epidural anesthesia group (P>0.05). The results of Cox regression analysis showed that anesthetic method and preoperative SpO2 difference were independent risk factors for cesarean section-related adve

关 键 词：高血压 肺性 麻醉 剖宫产术 预后 

分 类 号：R614[医药卫生—麻醉学]