腰硬联合麻醉下臀位外倒转术成功的影响因素  

Influencing factors of successful external breech conversion under combined spinal-epidural anesthesia

作　　者：肖培汉 姚文水 张华乐 王菁[1] XIAO Peihan;YAO Wenshui;ZHANG Huale;WANG Jing(Department of Anesthesiology,Fujian Maternity and Child Health Hospital,College of Clinical Medicine for Obstetrics&Gynecology and Pediatrics,Fujian Medical University,Fujian Province,Fuzhou350001,China;Department of Obstetrics and Gynecology,Fujian Maternity and Child Health Hospital,College of Clinical Medicine for Obstetrics&Gynecology and Pediatrics,Fujian Medical University,Fujian Province,Fuzhou350001,China)

机构地区：[1]福建省妇幼保健院福建医科大学妇儿临床医学院麻醉科,福建福州350001 [2]福建省妇幼保健院福建医科大学妇儿临床医学院妇产科,福建福州350001

出　　处：《中国当代医药》2023年第34期72-75,共4页China Modern Medicine

基　　金：福建省卫生健康科技计划项目(2022TG017)。

摘　　要：目的探讨首次无麻醉下外倒转术失败的孕妇在腰硬联合麻醉下再次行外倒转术的成功率及其影响因素。方法回顾性分析2017年1月至2021年6月福建省妇幼保健院在无麻醉下行臀位外倒转术失败并自愿在腰硬联合麻醉下再次行外倒转术的89例孕妇的临床资料,将所有孕妇分为成功组和失败组。分析孕妇年龄、术前体重指数、孕龄、局部麻醉药剂量、羊水指数、产次、麻醉穿刺部位、麻醉平面、胎儿脊柱位置、胎盘位置、臀先露类型对腰硬联合麻醉下外倒转术成功率的影响。结果首次无麻醉下外倒转术失败的孕妇在腰硬联合麻醉下再次行外倒转术的成功率为42.7%。单因素分析结果显示,成功组和失败组孕妇的产次、麻醉平面比较,差异有统计学意义(P<0.05)。多因素分析结果显示,经产(β=1.948,OR=7.013,95%CI:2.289~21.484)、麻醉平面达到胸6水平(β=-1.752,OR=0.173,95%CI:0.051~0.586)是首次无麻醉下外倒转术失败在腰硬联合麻醉下再次行外倒转术成功的影响因素(P<0.05)。结论孕妇产次和麻醉平面是首次无麻醉下外倒转术失败在腰硬联合麻醉下再次行外倒转术成功的影响因素。Objective To investigate the success rate and influencing factors of external conversion in pregnant women who failed the first external conversion without anesthesia under combined spinal-epidural anesthesia.Methods From January 2017 to June 2021,the data of 89 pregnant women who failed external breech conversion without anesthesia and voluntarily underwent external conversion again under combined spinal-epidural anesthesia in Fujian Maternal and Child Health Hospital were retrospectively analyzed,and they were divided into successful group and failed group.The effects of age,preoperative body mass index,gestational age,local anesthetic dose,amniotic fluid index,delivery time,anesthesia puncture site,anesthesia plane,fetal spinal position,placenta position,gluteal presentation type on the success rate of external conversion under combined lumbar and epidural anesthesia of pregnant women were analyzed.Results The success rate of external conversion under combined spinal-epidural anesthesia was 42.7%in pregnant women who failed the first external conversion without anesthesia.The results of single factor analysis showed that there were statistically significant differences between successful group and failed group in terms of delivery time and the level of anesthesia plane(P<0.05).The results of multivariate analysis showed that multiparity(β=1.948,OR=7.013,95%CI:2.289-21.484)and the anesthesia level reached the level of thoracic 6(β=-1.752,OR=0.173,95%CI:0.051-0.586)were the influential factors for the failure of the first external conversion without anesthesia and the success of the second external version under combined spinal-epidural anesthesia(P<0.05).Conclusion Terms of delivery time and the level of anesthesia are the influencing factors of the failure of the first external conversion without anesthesia and the success of the second external version under combined spinal-epidural anesthesia.

关 键 词：臀位 腰硬联合麻醉 外倒转术 影响因素 

分 类 号：R714.44[医药卫生—妇产科学]