妊娠合并胎盘植入产妇行剖宫产围手术期麻醉多学科管理分析  

Analysis of multidisciplinary management of perioperative anesthesia for cesarean section in pregnant patients with placenta implantation

作　　者：王艳双 车向明[1] 徐铭军[1] Wang Yanshuang;Che Xiangming;Xu Mingjun(Department of Anesthesiology,Bejing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院,北京妇幼保健院麻醉科,北京100026

出　　处：《国际麻醉学与复苏杂志》2024年第11期1169-1174,共6页International Journal of Anesthesiology and Resuscitation

基　　金：中国产科麻醉和分娩镇痛及相关并发症调查研究(CMCHA-XM-2022-051)。

摘　　要：目的总结妊娠合并胎盘植入产妇行剖宫产围手术期的麻醉管理经验。方法纳入2017年10月至2022年4月出院诊断为"剖宫产、胎盘植入或凶险性前置胎盘合并胎盘植入"产妇的病例资料92例, 根据胎盘植入程度分为粘连型组(A组, 19例)、植入型组(B组, 43例)、穿透型组(C组, 30例)。记录产妇一般情况(年龄、身高、体重、孕次、产次、孕周)、麻醉方式、术前腹主动脉球囊和(或)输尿管支架放置情况、手术时长、住院时间、出血量、手术前后纤维蛋白原(FIB)丢失量、术中输入血制品(悬浮红细胞、新鲜冰冻血浆、自体血、FIB、凝血酶原复合物、氨甲环酸)情况、产妇预后[切除子宫情况、重症监护治疗病房(ICU)入住率]及新生儿情况(身长、体重、Apgar评分)。结果 3组产妇一般情况差异无统计学意义(均P>0.05)。与A组比较:C组孕周较短, 手术时长、住院时间较长, 输尿管支架放置率较高, 输入悬浮红细胞、新鲜冰冻血浆、自体血、氨甲环酸较多, 子宫切除率较高, 新生儿身长较短、体重较轻(均P<0.05);B组、C组椎管内麻醉比例较低, 全麻比例较高, 出血量较多, 腹主动脉球囊放置率较高, ICU入住率较高(均P<0.05)。与B组比较, C组手术时长、住院时间较长, 出血量较多, 腹主动脉球囊放置率、输尿管支架放置率较高, 输入悬浮红细胞、新鲜冰冻血浆、自体血、氨甲环酸较多, 新生儿身长较短、体重较轻, 子宫切除率、ICU入住率较高(均P<0.05)。3组产妇手术前后FIB丢失量、输入FIB、输入凝血酶原复合物及新生儿Apgar评分差异无统计学意义(均P>0.05)。结论胎盘植入产妇行剖宫产围手术期的麻醉目前仍以椎管内麻醉为主;采用自体血回输无不良反应发生, 进一步证实自体血回输安全、有效;术前放置腹主动脉球囊使患者术中出血量减少, 子宫切除率明显下降;多学科会诊、围手术期精细�Objective To summarize anesthetic management experience for cesarean section in pregnant women with placen-ta implantation during the perioperative period.Methods A total of 92 pregnant women who were diagnosed with"cesarean section,placenta implantation,or placenta implantation in combination with placenta previa"from October 2017 to April 2022 were selected and their clinical data were analyzed.According to the degree of placental invasion,the patients were divided into three groups:adher-ent type group(group A,n=19),invasive type group(group B,n=43),and penetrating type group(group C,n=30).Their general mater-nal information(age,height,body weight,number of pregnancies and deliveries,and gestational age),anesthesia method,preoperative placement of abdominal aortic balloons and(or)ureteral stents,surgical duration,length of hospitalization stay,blood loss,and fibrino-gen(FIB)loss before and after surgery,intraoperative blood product transfusions(packed red blood cells,fresh frozen plasma,autolo-gous blood,FIB,prothrombin complex,and tranexamic acid),maternal outcomes[rate of hysterectomy,and intensive care unit(ICU)ad-mission rate],and neonatal outcomes(length,body weight,and Apgar score)were recorded.Results There was no statistically sig-nificant difference in the general conditions of the 3 groups of mothers.Compared with group A,group C showed decreases in gestation-al age,and increases in surgical duration,hospitalization stay,ureteral stent placement rate,transfusion volume of packed red blood cells,fresh frozen plasma,autologous blood,and tranexamic acid,and higher hysterectomy rate,and decreases in neonatal length and body weight(all P<0.05).Groups B and C presented lower rates of spinal anesthesia,higher rates of general anesthesia,higher blood loss,higher rates of abdominal aortic balloon placement,and higher ICU admission rates than group A(all P<0.05).Compared with group B,group C had increased surgical duration,hospitalization stay,blood loss,rates of abdominal aortic balloon and ureteral stent pla

关 键 词：妊娠 胎盘植入 剖宫产 围手术期 麻醉 

分 类 号：R714.3[医药卫生—妇产科学]