无痛分娩中转剖宫产麻醉方法的选择分析  

Analysis of the Selection of Anesthesia Methods for Painless Labor Transfer to Cesarean Section.

作　　者：杨淖绚 杜宇 陈盈艮 赵于 周述芝[2] Yang Zhuoxuan;Du Yu;Chen Yingyin(North Sichuan Medical College,Nanchong,Sichuan 637000;Department of Anesthesiology,Ya an People's Hospital,Ya an,Sichuan 625000;Nanchong Central Hospital Affiliated to North Sichuan Medical College,Nanchong,Sichuan 637000,China.)

机构地区：[1]川北医学院,四川南充637000 [2]雅安市人民医院麻醉科,四川雅安625000 [3]川北医学院附属南充市中心医院,四川南充637000

出　　处：《四川医学》2024年第10期1113-1117,共5页Sichuan Medical Journal

摘　　要：目的分析无痛分娩中转为剖宫产麻醉方法选择的影响因素、术中指标和新生儿结局,为产妇提供安全有效的麻醉管理。方法收集2018年1月至2023年7月我院接受无痛分娩中转为剖宫产的单胎初产妇临床资料,根据麻醉方式分为全身麻醉(GA)组、持续硬膜外麻醉(CEA)组、腰硬联合麻醉(CSEA)组,分析选择不同麻醉方法的影响因素、术中指标及新生儿结局。结果研究共纳入404例中转剖宫产的产妇,中转原因为胎儿宫内窘迫、头盆不称、产程异常、持续性枕横(后)位及社会因素。根据麻醉方法分为GA组39例、CEA组277例、CSEA组88例。CEA组、CSEA组胎儿宫内窘迫占比低于GA组,差异有统计学意义(P<0.05);CSEA组社会因素占比高于CEA组,差异有统计学意义(P<0.05)。CEA组、CSEA组产妇入室至切皮时间长于GA组,且CSEA组长于CEA组,差异有统计学意义(P<0.05);GA组、CEA组产妇术中补液量低于CSEA组,且CEA组低于GA组,差异有统计学意义(P<0.05);GA组、CEA组产妇术中低血压发生率明显低于CSEA组,差异有统计学意义(P<0.05);CEA组与CSEA组比较,CEA组麻醉平面更低、转化GA率及术中镇痛补救率更高、恶心呕吐发生率更低,差异有统计学意义(P<0.05)。新生儿出生后1 min、5 min、10 min Apgar评分差异无统计学意义(P>0.05)。结论无痛分娩中转剖宫产麻醉方法主要采用CEA,其次为CSEA,GA占比最低,3种麻醉方式均不影响新生儿评分;GA在胎儿宫内窘迫等紧急情况下采用更广泛,CEA与CSEA各具特点。Objective To analyze the influencing factors of anesthesia method selection,intraoperative indicators and neonatal outcomes when converting from painless labor to cesarean section,in order to provide safe and effective anesthesia management for parturients.Methods Clinical data of singleton primiparous women who underwent conversion from painless labor to cesarean section in our hospital from January 2018 to July 2023 was collected.According to the anesthesia method,they were divided into,general anesthesia(GA)group,continuous epidural anesthesia(CEA)group,and combined spinal-epidural anesthesia(CSEA)group.The factors influencing the selection of different anesthesia methods,intraoperative indicators,and neonatal outcomes were analyzed.Results A total of 404 puerpera were included in the study.The reasons for cesarean section included fetal distress,cephalopelvic disproportion,abnormal labor,persistent occiput transverse(posterior)position,and social factors.According to the anesthesia method,they were divided into GA group(39 cases),CEA group(277 cases),and CSEA group(88 cases).The proportion of fetal distress in the CEA and CSEA groups was lower than that in the GA group(P<0.05).The proportion of social factors in the CSEA group was higher than that in the CEA group(P<0.05).The time from entering the operating room to skin incision in the CEA and CSEA groups was longer than that in the GA group,and in which the CSEA group was longer than that in the CEA group(P<0.05).The intraoperative fluid volume in the GA and CEA groups was lower than the CSEA group,and in which the CEA group was lower than that in the GA group(P<0.05).The incidence of intraoperative hypotension in the GA and CEA groups was lower than that in the CSEA group(P<0.05).Comparing CEA group with CSEA group,the CEA group had a lower anesthesia level,higher conversion rate to GA,higher rate of intraoperative analgesia rescue,and lower incidence of nausea and vomiting(P<0.05).There was no statistically significant difference in the neonatal Apgar sco

关 键 词：无痛分娩 麻醉方法 剖宫产 

分 类 号：R713.6[医药卫生—妇产科学] R614[医药卫生—临床医学]