不同麻醉方法对剖宫产术后早期血常规炎症指标及康复的影响比较  

A comparative study on the effect of different anesthesia methods on early postoperative inflammatoryindicators and rehabilitation in patients undergoing cesarean section

作　　者：郑客松 康芳 韩明明 杨成伟 黄祥 李娟[1] ZHENG Kesong;KANG Fang;HAN Mingming;YANG Chengwei;HUANG Xiang;LI Juan(Department of Anesthesiology,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China(Anhui Provincial Hospital),Hefei,Anhui 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)麻醉科,安徽合肥230001

出　　处：《中华全科医学》2024年第1期34-38,共5页Chinese Journal of General Practice

基　　金：安徽省自然科学基金项目(2108085MH323)。

摘　　要：目的 评价不同麻醉方法对剖宫产产妇术后炎症标志物及康复的影响,为剖宫产手术选择麻醉方式提供参考。方法 选取2022年1月—2023年5月中国科学技术大学附属第一医院南区急诊剖宫产产妇1 759例,根据麻醉方式分为全身麻醉组(G组,200例)和硬膜外麻醉组(E组,1 559例),按纳入排除标准及倾向性评分法1∶1匹配后比较2种麻醉方法对患者术后白细胞(WBC)、血小板与淋巴细胞比率(PLR)、中性粒细胞与淋巴细胞比率(NLR)、单核细胞与淋巴细胞比率(MLR)及康复的影响。结果 E组患者术后WBC、NLR及MLR较术前明显升高(均P<0.05),G组患者术后WBC、PLR、NLR及MLR较术前均明显升高(P<0.05)。与E组相比,G组手术前后PLR差值[16.78(0.16,29.36)vs.-2.20(-21.69,15.17)]升高(P<0.05)。与E组比较,G组患者麻醉开始到胎儿娩出时间[6(3,12)min vs.43(32,54)min]和切皮到胎儿娩出时间[3(2,7)min vs.7(6,12)min]均缩短(P<0.05),术后肠道通气时间[44(39,46)h vs.39(36,43)h]延长(P<0.05)。切皮前5 min和切皮时E组的MAP和HR均明显低于G组(P<0.05)。2组患者术中出血量及术后住院时间比较差异均无统计学意义(P>0.05)。结论 硬膜外麻醉可能更利于产妇康复,全身麻醉适合需紧急娩出胎儿的情况。Objective To evaluate the effects of different anaesthetic methods on inflammatory markers and rehabilitation after caesarean section,and provide a reference for the selection of anaesthetic methods for caesarean section surgery.Methods A total of 1759 patients undergoing emergency caesarean section in the Southern District of the First Affiliated Hospital of the University of Science and Technology of China from January 2022 to May 2023 were divided into general anaesthesia group(group G,n=200)and epidural anaesthesia group(group E,n=1559).The parturients were selected according to specific inclusion and exclusion criteria,and then the parturients in the two groups were matched in a 1∶1 ratio using the propensity score method.The effects of two different anaesthetic methods on white blood cell(WBC),platelet to lymphocyte ratio(PLR),neutrophil to lymphocyte ratio(NLR),monocyte to lymphocyte ratio(MLR)and postoperative rehabilitation were compared.Results WBC,NLR and MLR in group E were significantly higher than those before surgery,while WBC,PLR,NLR and MLR in group G were significantly higher than those before surgery.Compared with group E,the difference of PLR before and after surgery in group G[16.78(0.16,29.36)vs.-2.20(-21.69,15.17)]was significantly higher(P<0.05).In group G,the time from induction of anaesthesia to fetal delivery[6(3,12)min vs.43(32,54)min]and the time from skin incision to fetal delivery[3(2,7)min vs.7(6,12)min]were significantly shortened,whereas the postoperative farting time[44(39,46)h vs.39(36,43)h]was significantly longer(P<0.05).At 5 minutes before skin incision and during skin incision,group E had significantly lower MAP and HR compared to group G(P<0.05).There were no significant differences in intraoperative blood loss and postoperative hospital stay between the two groups(P>0.05).Conclusion Epidural anaesthesia may be more beneficial for the mother's recovery,while general anaesthesia is appropriate for emergency delivery of the fetus.

关 键 词：剖宫产术 麻醉方法 血小板与淋巴细胞比率 中性粒细胞与淋巴细胞比率 单核细胞与淋巴细胞比率 

分 类 号：R614[医药卫生—麻醉学] R719.8[医药卫生—外科学]