二代喉罩对全身麻醉剖宫产母儿结局的影响  

Effects of the second generation laryngeal mask airway under general anesthesia on maternal and neonatal outcomes in cesarean delivery

作　　者：耿志宇[1] 李纯青[1] Geng Zhiyu;Li Chunqing(Department of Anesthesiology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院麻醉科,100034

出　　处：《中华围产医学杂志》2021年第12期885-890,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨二代喉罩对全身麻醉(简称全麻)剖宫产母儿结局的影响。方法回顾性纳入2015年1月至2019年12月在北京大学第一医院接受需要气道干预全麻剖宫产手术的544例产妇。按全麻时选择的不同气道工具,将产妇分为气管插管组(n=379)和喉罩组(SupremeTM喉罩,n=165)。对2组中的单胎妊娠产妇使用logistic回归模型进行倾向性评分匹配,匹配后每组133例。主要结局指标为新生儿生后1 min窒息(1 min Apgar评分≤7分)的比例。次要结局指标为新生儿生后1 min重度窒息(1 min Apgar评分≤3分)、5 min窒息(5 min Apgar评分≤7分)和转新生儿重症监护病房的比例;产妇反流、误吸、低氧血症和转重症监护病房的比例,以及术后全因发病率和院内病死率。采用两独立样本t检验、Mann-Whitney U检验和χ^(2)检验进行统计学分析。结果544例中有2例困难气道患者,其中1例在气管插管失败后选择喉罩补救气道成功。所有产妇均未发生反流、误吸及麻醉相关死亡。倾向性评分匹配后,喉罩组与气管插管组相比,新生儿生后1 min窒息的发生比例差异无统计学意义[15.8%(21/133)与19.5%(26/133),χ^(2)=0.646,P=0.422]。喉罩组与气管插管组新生儿生后1 min重度窒息[2.3%(3/133)与3.0%(4/133),χ^(2)<0.001,P>0.999]、5 min窒息[4.5%(6/133)与4.5%(6/133),χ^(2)<0.001,P>0.999]、转新生儿监护病房[27.8%(37/133)与38.3%(51/133),χ^(2)=3.328,P=0.068]以及产妇术中低氧血症[1.5%(2/133)与4.5%(6/133),χ^(2)=1.160,P=0.281]、转重症监护病房[3.8%(5/133)与9.0%(12/133),χ^(2)=3.079,P=0.079]的比例及全因发病率[2.3%(3/133)与2.3%(3/133),χ^(2)=0.171,P=0.680]差异均无统计学意义。结论二代喉罩(Supreme^(TM))不增加全麻剖宫产母儿不良结局的风险,可以与气管插管一样用于全麻剖宫产术。Objective To evaluate the effects of the second generation laryngeal mask airway(LMA)under general anesthesia on maternal and neonatal outcomes in cesarean delivery.Methods This study retrospectively enrolled 544 patients who underwent cesarean delivery under general anesthesia with airway intervention in Peking University First Hospital between January 2015 and December 2019.Patients were divided into endotracheal tube group(ETT group,n=379)and LMA group(SupremeTM LMA,n=165)according to the airway devices used under general anesthesia.Propensity score matching was carried out using a multivariable logistic regression model and 133 cases of singleton pregnancies were matched in each group.The main outcome was the incidence of neonatal asphyxia at one minute after birth(1 min Apgar score≤7).The secondary neonatal outcomes were the incidence of severe asphyxia at one minute after birth(1 min Apgar score≤3)and asphyxia at five minutes after birth(5 min Apgar score≤7)and the percentage of neonates transferred to neonatal intensive care unit.The secondary maternal outcomes included the incidence of regurgitation,aspiration and hypoxemia,the percentage transferred to intensive care unit,post-operation all-cause morbidity and fatality before discharge.Two independent samples t-test,Mann-Whitney U test and Chi-square test were used for statistical analysis.Results Two of the 544(0.4%)patients had difficulty in intubation and one of them was successfully ventilated with LMA after failed intubation.No regurgitation,aspiration or anesthesia-related death was reported.After the propensity score matching,the incidence of neonatal asphyxia at one minute after birth in the LMA group and the ETT group had no significant difference[15.8%(21/133)vs 19.5%(26/133),χ^(2)=0.646,P=0.422].Moreover,there were no differences between the LMA and ETT group regarding the incidence of severe asphyxia at one minute after birth[2.3%(3/133)vs 3.0%(4/133),χ^(2)<0.001,P>0.999]or asphyxia at five minutes after birth[4.5%(6/133)vs 4.5%(6/133

关 键 词：剖宫产术 麻醉 全身 喉罩 新生儿窒息 

分 类 号：R614.2[医药卫生—麻醉学]