不同类型胎盘植入对剖宫产患者麻醉方式选择的影响

目的探讨不同类型胎盘植入对剖宫产患者麻醉方式选择及手术效果的影响。方法回顾性分析于我院行剖宫产手术的胎盘植入产妇300例,根据胎盘植入严重程度将其分为粘连组(181例)、植入组(73例)及穿透组(46例),分析3组的麻醉方式实施率、术中及术后凝血功能指标、并发症情况。结果粘连组椎管内麻醉实施率明显高于植入组和穿透组,全身麻醉和复合麻醉实施率明显低于植入组和穿透组,差异均有统计学意义(P<0.05);植入组和穿透组全身麻醉实施率比较,差异无统计学意义(P>0.05),植入组椎管内麻醉实施率高于穿透组,复合麻醉实施率低于穿透组,差异均具有统计学意义(P<0.05)。3组产妇术中PLT、APTT、Fib及术后APTT、Fib、PT比较,差异无统计学意义(P>0.05);植入组和穿透组术中PT比较,差异无统计学意义(P>0.05),但均低于粘连组,差异有统计学意义(P<0.05);粘连组术后PLT明显低于植入组和穿透组,且植入组术后PLT明显低于穿透组,差异均有统计学意义(P<0.05)。粘连组胎儿窘迫、新生儿窒息发生率低于植入组和穿透组,植入组上述并发症发生率均低于穿透组,差异均具有统计学意义(P<0.05);粘连组产妇弥散性血管内凝血、产后出血、产褥感染发生率低于植入组和穿透组,植入组上述并发症发生率均低于穿透组,差异均具有统计学意义(P<0.05)。粘连组新生儿NICU入住率、围生期死亡率均低于植入组及穿透组,植入组以上指标均低于穿透组,差异具有统计学意义(P<0.05);粘连组新生儿Apgar评分高于植入组及穿透组,植入组新生儿Apgar评分高于穿透组,差异具有统计学意义(P<0.05)。粘连组产妇出血量低于植入组和穿透组,植入组产妇出血量低于穿透组,差异均有统计学意义(P<0.05)。结论对于胎盘植入的产妇应预先了解其严重程度,从而选择适宜的麻醉方式,在无禁忌证的前提下,应以椎管内麻醉为主,并在围生期给与相应的处理措施。

Effect of different types of placenta accreta on anesthesia selection in patients with cesarean section

Objective To investigate the effect of different types of placenta accreta on anesthesia selection and surgical effect in patients with cesarean section.Methods A retrospective analysis of 300 cases of placenta accreta who underwent cesarean section in our hospital was conducted.According to the severity of placenta accreta,they were divided into the adhesion group(181 cases),the implantation group(73 cases)and the penetration group(46 cases).The implementation rate of anesthesia,intraoperative and postoperative coagulative function indexes and complications were analyzed among the three groups.Results The implementation rate of intraspinal anesthesia in the adhesion group was significantly higher than that in the implantation group and the penetration group,while the implementation rate of general anesthesia and compound anesthesia were significantly lower than those in the implantation group and the penetration group,with statistically significant differences(P<0.05).There was no significant difference in the implementation rate of general anesthesia between the implantation group and the penetration group(P>0.05).The implementation rate of intraspinal anesthesia in the implantation group was higher than that in the penetration group,while the implementation rate of compound anesthesia was lower than that in the penetration group,with statistically significant differences(P<0.05).There was no significant difference in intraoperative PLT,APTT,Fib and postoperative APTT,Fib,PT among the three groups(P>0.05).There was no significant difference in intraoperative PT between the implantation group and the penetration group(P>0.05),but they were lower than that in the adhesion group,with statistically significant difference(P<0.05).The postoperative PLT of the adhesion group was significantly lower than that of the implantation group and the penetration group,and the postoperative PLT of the implantation group was significantly lower than that of the penetration group,the differences were statistically significant(P<0.05).The incidences of fetal distress and neonatal asphyxia in the adhesion group were lower than those in the implantation group and the penetration group,and the incidences of the above complications in the implantation group were lower than those in the penetration group,and the differences were statistically significant(P<0.05).The incidences of maternal disseminated intravascular coagulation,postpartum hemorrhage and puerperal infection in the adhesion group were significantly lower than those in the implantation group and the penetration group,and the incidences of the above complications in the implantation group were lower than those in the penetration group,and the differences were statistically significant(P<0.05).The NICU occupancy rate and perinatal mortality rate of the newborn in the adhesion group were lower than those in the implantation group and the penetration group,and the above indexes in the implantation group were lower than those in the penetration group,with statistically significant difference(P<0.05).The neonatal Apgar score in the adhesion group was higher than that in the implantation group and the penetration group,and the neonatal Apgar score in the implantation group was higher than that in the penetration group,with statistically significant difference(P<0.05).The maternal blood loss in the adhesion group was less than that in the implantation group and the penetration group,and the maternal blood loss in the implantation group was less than that in the penetration group,with statistically significant difference(P<0.05).Conclusion For parturient women with placenta accreta,the severity of placenta accreta should be known in advance,so as to choose the appropriate anesthesia method.Under the premise of no contraindication,intraspinal anesthesia should be given priority,and corresponding treatment measures should be given in the perinatal period.