全身麻醉下剖宫产术的单中心回顾性队列研究

doi:10.24920/003541

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The multiple reasons for choosing general anesthesia for cesarean section are presented and dissussed. Pregnancy with internal or surgical diseases was shown as the most common reason. Factors that are related to the high postoperative ICU ratio for parturients and low one-minute Apgar score for neonates are studied.

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

Funding: Fund supported by the CAMS Innovation Fund for Medical Sciences(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.

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References 19.

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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)

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

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