全身麻醉下剖宫产术的单中心回顾性队列研究

doi:10.24920/003541

Chinese Medical Sciences Journal ›› 2019, Vol. 34 ›› Issue (4): 256-262.doi: 10.24920/003541

全身麻醉下剖宫产术的单中心回顾性队列研究

李旭^1,^#,吴蔽野^1,^2,^#,张明珠^1,³,申乐^1,^*()

^1. 中国医学科学院北京协和医院麻醉科,北京,100730中国
^2. 复旦大学附属肿瘤医院麻醉科,上海,200032中国
^3. 中国医学科院肿瘤医院麻醉科,北京,100021中国

收稿日期:2018-11-17 接受日期:2019-04-29 出版日期:2019-12-31 发布日期:2019-12-04
通讯作者: 李旭,吴蔽野,申乐 E-mail:pumchshenle@aliyun.com

A Single-center Retrospective Cohort Study on Cesarean Section under General Anesthesia

Li Xu^1,^#,Wu Biye^1,^2,^#,Zhang Mingzhu^1,³,Shen Le^1,^*()

^1. Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
^2. Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
^3. Department of Anesthesiology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China

Received:2018-11-17 Accepted:2019-04-29 Published:2019-12-31 Online:2019-12-04
Contact: Li Xu,Wu Biye,Shen Le E-mail:pumchshenle@aliyun.com

摘要/Abstract

摘要： 目的椎管内阻滞是剖宫产术最常用的麻醉方法,而在某些情况下全身麻醉在剖宫产术中发挥重要作用。本研究旨在分析选择全身麻醉进行剖宫产的原因以及可能影响母婴结局的因素。方法回顾性搜集北京协和医院在2014年1月1日至2016年12月31日期间进行全身麻酔的剖宫产产妇和新生儿的临床资料（产妇基本情况,术前状态,围术期情况以及母婴预后）。搜集并分析选择全身麻醉的主要原因,分析产妇返回ICU继续监护与ASA 分级（Ⅲ-Ⅳ vs.Ⅰ-Ⅱ）、孕周（<37周vs. ≥37周）、术中失血量（<800 ml vs. ≥800 ml）的相关性,并比较不同ASA分级和孕周的产妇其胎儿的1分钟Apgar评分情况的差异。结果本研究共纳入98例全麻剖宫产术的产妇。在母婴的多种因素中,妊娠合并内科或外科疾病是选择全身麻醉的主要原因（59例,60.2％）,其次是妊娠合并胎盘和胎膜异常（38例,38.8％）和妊娠特异性疾病（36例,36.7％）。ASA分级Ⅲ-Ⅳ（χ ²=44.3,P<0.05),孕周<37周（χ ²=23.4,P<0.05）,出血量>800 ml的产妇（χ ²=5.5,P<0.05）,其术后返ICU的比率较高。产妇住院时间在ASA分级Ⅲ-Ⅳ（t=-2.99,P<0.05）及孕周<37周（t=2.47,P<0.05）的产妇中明显更长。新生儿1分钟Apgar评分在ASA分级Ⅲ-Ⅳ（t=2.21,P<0.05）以及孕周<37周（t=-3.21,P<0.05）的产妇明显较低。结论妊娠合并内科和外科疾病是剖宫产手术选择全身麻醉的最常见原因。ASA分级高,孕周短于37周的产妇术后需要ICU照护的比率较高,住院时间更长,新生儿1分钟Apgar评分较低。

关键词: 全身麻醉, 剖宫产术, 病因, 母婴预后

Abstract: Objective Neuraxial block is the most common anesthesia method for cesarean section (CS). However, for some urgent and high-risk cesarean delivery, general anesthesia (GA) also plays a very important role. We aimed to find out the reasons of choosing GA for CS in our center and the factors that may be related to the maternal and fetal outcomes.Methods We retrospectively selected parturients who had CS procedures under GA in Peking Union Medical College Hospital from January 1, 2014 to December 31, 2016. Clinical data (baseline maternal status, preoperative status, perioperative information, maternal and fetal outcomes) of parturients and neonates were collected and analyzed. We summarized the common reasons for applying general anesthesia, and compared the back-to-ICU ratio and hospital stay time between parturients with different maternal American Society of Anesthesiologists (ASA) grade, gestational weeks and intraoperative blood loss, as well as the fetal one-minute Apgar score between different maternal ASA grade and gestational weeks.Results There were 98 cases of CS under GA enrolled in the study. Among the maternal and fetal factors, pregnancy with internal or surgical diseases is the most common reason (59 cases, 60.2%) for choosing GA, followed by the placenta and fetal membrane abnormalities (38 cases, 38.8%) and the pregnancy-specific disorders (36 cases, 36.7%). ASA grade Ⅲ-Ⅳ of parturients (χ ²=44.3, P<0.05), gestation period < 37 weeks (χ ²=23.4, P<0.05), and blood loss > 800 ml (χ ²=5.5, P<0.05) were related to the higher postoperative intensive care unit (ICU) rate in parturients. ASA grade Ⅲ-Ⅳ of parturients (t=-2.99, P<0.05), gestation period < 37 weeks (t=2.47, P<0.05) were related to the longer hospital stay. ASA grade Ⅲ-Ⅳ of parturients (t=2.21, P=0.01) and gestation period < 37 weeks (t=-3.21, P=0.002) were related to the lower one-minute Apgar score of neonates. Conclusion Pregnancy with internal or surgical diseases is the most common reason for choosing GA for CS. High ASA grade and short gestation period were the related factors of high postoperative ICU ratio for parturients and low one-minute Apgar score for neonates.

Key words: general anesthesia, cesarean section, pathogenies, maternal and neonate outcome

基金资助: 中国医学科学院医学与健康科技创新工程基金(CIFMS 2016-12M-3-024)

Li Xu, Wu Biye, Zhang Mingzhu, Shen Le. A Single-center Retrospective Cohort Study on Cesarean Section under General Anesthesia[J].Chinese Medical Sciences Journal, 2019, 34(4): 256-262.

图/表 4

参考文献 19.

1.	Ghaffari S, Dehghanpisheh L, Tavakkoli F , et al. The effect of spinal versus general anesthesia on quality of life in women undergoing cesarean delivery on maternal request. Cureus 2018; 10(12):e3715. doi: 10.7759/cureus.3715.
2.	Jeffrey LA, Joy LH, Madhulika A , et al. Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016; 124(2):270-300. doi: 10.1097/ALN.0000000000000935.
3.	Sun HL, Ling QD, Sun WZ , et al. Lower limb wrapping prevents hypotension, but not hypothermia or shivering, after the introduction of epidural anesthesia for cesarean delivery. Anesth Analg 2004; 99(1):241-5. doi: 10.1213/01.ane.0000121346.33443.5a.
4.	Turnbull J, Bell R . Obstetric anaesthesia and peripartum management. Best Pract Res Clin Obstet Gynaecol 2014; 28(4):593-605. doi: 10.1016/j.bpobgyn.2014.03.008.
5.	?ule ?, Bahar KB, Belk?s ? . Anaesthesia for caesarean section of pregnant women with idiopathic thrombocytopenic purpura. Turk J Anaesthesiol Reanim 2013; 41(5):175-7. doi: 10.5152/TJAR.2013.21.
6.	Linden OL, Brian TB, Sachin K , et al. Risk of epidural hematoma after neuraxial techniques in thrombocytopenic parturients: a report from the multicenter perioperative outcomes group. Anesthesiology 2017; 126:1053-63. doi: 10.1097/ALN.0000000000001630.
7.	WHO Recommendations for Prevention and Treatment of Pre-Eclampsia and Eclampsia. Geneva: World Health Organization; 2011. Summary of recommendations. https://www.ncbi.nlm.nih.gov/books/NBK140555/. Accessed November 21, 2019.
8.	Rosário G, ?ngela M . Gestational diabetes mellitus: A risk factor for non-elective cesarean section. J Obstet Gynaecol Res 2012; 38(1):154-9. doi: 10.1111/j.1447-0756.2011. 01659.x.
9.	Waters TP, Mercer BM . The management of preterm premature rupture of the membranes near the limit of fetal viability. Am J Obstet Gynecol 2009; 201(3):230-40. doi: 10.1016/j.ajog.2009.06.049.
10.	Packard RE, Mackeen AD . Labor induction in the patient with preterm premature rupture of membranes. Semin Perinatol 2015; 39(6):495-500. doi: 10.1053/j.semperi.2015.07.015.
11.	Borthen I, Eide MG, Veiby G , et al. Complications during pregnancy in women with epilepsy: population-based cohort study. Br J Obstet Gynaecol 2009; 116(13):1736-42. doi: 10.1111/j.1471-0528.2009.02354.x.
12.	Viinikainen K, Heinonen S, Eriksson K , et al. Community-based, prospective, controlled study of obstetric and neonatal outcome of 179 pregnancies in women with epilepsy. Epilepsia 2006; 47(1):186-92. doi: 10.1111/j.1528-1167.2006.00386.x.
13.	Voss LJ, Sleigh JW, Barnard JPM , et al. The howling cortex: seizures and general anesthetic drugs. Anesth Analg 2008; 107(5):1689-703. doi: 10.1213/ane.0b013e3181852595.
14.	Olagbuji BN, Ezeanochie MC, Igbaruma S , et al. Stillbirth in cases of severe acute maternal morbidity. Int J Gynecol Obstet 2012; 119(1):53-6. doi: 10.1016/j.ijgo.2012.05.032.
15.	Murphy KW, Johnson P, Moorcraft J , et al. Birth asphyxia and the intrapartum cardiotocograph. Br J Obstet Gynaecol 1990; 97(6):470-9. doi: 10.1111/j.1471-0528.1990.tb02515.x.
16.	Olagundoye V, Black R, Mackenzie IZ . Impact of the severity of fetal distress on decision-to-delivery intervals for assisted vaginal delivery. J Obstet Gynaecol 2008; 28(1):51-5. doi: 10.1080/01443610701812132.
17.	Mancuso A, De Vivo A, Giacobbe A , et al. General versus spinal anaesthesia for elective caesarean sections: effects on neonatal short-term outcome. A prospective randomised study. J Matern Fetal Neonatal Med 2010; 23(10):1114-8. doi: 10.3109/14767050903572158.
18.	Harazim H, Stourac P, Blaha J , et al. The influence of mode of anaesthesia for caesarean delivery on neonatal Apgar scores in the Czech Republic and Slovakia: secondary analysis of the results of an international survey in 2015. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 163(2):147-54. doi: 10.5507/bp.2019.008.
19.	Laudenbach V, Mercier FJ, Rozé JC , et al. Anaesthesia mode for caesarean section and mortality in very preterm infants: an epidemiologic study in the EPIPAGE cohort. Int J Obstet Anesth 2009; 18(2):142-9. doi: 10.1016/j.ijoa.2008.11.005.

Category	Pathogenies	n	%
Maternal factors
	Pregnancy-specific disorders: eclampsia, HELLP syndrome, gestational diabetes.	36	36.7
	Pregnancy with internal or surgical diseases: anemia, thrombocytopenia, idiopathic thrombocytopenic purpura, acute fatty liver, fatty liver, acute pancreatitis, systemic lupus erythematosus, antiphospholipid antibody syndrome, hyperthyroidism, maternal hypothyroidism.	59	60.2
	Pregnancy with placenta or fetal membrane abnormalities: placenta previa, placental abruption, premature rupture of membranes.	38	38.8
	Pregnancy with amniotic fluid or umbilical cord abnormalities: amniotic fluid, oligohydramnios, umbilical cord abnormalities.	21	21.4
	Abnormal delivery: abnormal birth canal, abnormal force of labor abnormal fetal position.	8	8.2
	Complications during parturient period: uterine rupture.	2	2.0
	Pregnancy with orthopedic diseases: spine scoliosis, lumbar disc herniation.	7	7.1
	Pregnancy with infection: colpitis mycotica, vaginal Candida albicans infection.	3	3.1
	Pregnancy with mental illness: epilepsy, bi-directional affective disorder.	3	3.1
Fetal factors
	Intrauterine distress	19	19.4
	Stillbirth	6	6.1
	Macrosomia	4	4.1
	Fetal congenital malformation	1	1.0
	Fetal growth restriction	1	1.0

Characteristics		Back to GW n (%)	Back to ICU n (%)	χ²	P
ASA score				44.3	<0.05
	Ⅰ-Ⅱ	44(76)	14(24)
	Ⅲ-IV	3(8)	37(92)
Gestation period (weeks)				23.4	<0.05
	<37	14(26)	40(74)
	≥37	33(75)	11(25)
Blood loss (ml)				5.5	<0.05
	<800	44(53)	39(47)
	≥800	3(20)	12(80)

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全身麻醉下剖宫产术的单中心回顾性队列研究

A Single-center Retrospective Cohort Study on Cesarean Section under General Anesthesia

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Characteristics		n	One-minute Apgar score§	t	P
ASA score				2.21	0.01
	Ⅰ-Ⅱ	58	7.6±2.1
	Ⅲ-IV	40	6.4±2.9
Gestation period (weeks)				-3.21	0.002
	<37	54	6.5±2.4
	≥37	44	8.0±2.2