不同胎盘植入剖宫产手术产妇麻醉方式选择及母婴结局对比

目的探讨胎盘植入程度对剖宫产手术麻醉方案的选择及对母婴结局的影响。方法回顾性分析2014年1月至2019年12月在石家庄市妇幼保健院诊断为“胎盘置入”的病例,剔除自然产、剖宫取胎及人工流产病例,最终300例孕产妇被纳入本次研究中。根据胎盘植入程度将粘连型胎盘植入分为粘连组(n=112),植入型胎盘植入为植入组(n=100),穿透型胎盘植入为穿透组(n=88例)。比较3组基线资料、麻醉方案选择、术中相关指标、麻醉管理情况以及母婴结局。结果穿透组无剖宫产史比率(4.55%)低于植入组(33.00%)和粘连组(54.46%),1次剖宫产史比率(78.41%)高于植入组(55.00%)和粘连组(38.39%),差异均有统计学意义(P<0.05)。穿透组选择椎管内麻醉的比率(9.09%)明显低于植入组和粘连组(80.00%、93.75%),穿透组选择全身麻醉的比率(68.18%)明显高于植入组和粘连组(12.00%、5.36%),穿透组椎管内麻醉中转全身麻醉的比率(22.73%)明显高于植入组和粘连组(8.00%、0.89%),差异均有统计学意义(P<0.05)。胎盘植入程度越重,手术时间、麻醉时间、手术至胎儿娩出时间、住院时间越长,出血量越多,回收式自体血回输、保温措施、产妇子宫切除、转ICU治疗的比率越高,新生儿1 min Apgar评分越低,差异均有统计学意义(P<0.05)。结论对于胎盘植入程度较轻的患者首选的麻醉方式为椎管内麻醉,对术前检查胎盘植入程度较重的患者可根据术中出血量、血流动力学等情况更改合适的麻醉方式,以减少对母婴的不良影响。

Comparison of anesthesia methods and maternal and infant outcomes in different cesarean section with placenta accretasections.

Objective To investigate the effect of placental implantation degree on the option of anesthesia plan for cesarean section and on maternal and infant outcomes.Methods Retrospective analysis was performed in patients diagnosed as"placental implantation"in Shijiazhuang maternal and child health care hospital from January 2014 to December 2019,excluding those with spontaneous birth,cesarean delivery and induced abortion,and finally 300 pregnant women were enrolled in this study.According to the degree of placenta accreta,they were divided into adhesion group(n=112),placenta accreta(n=100)and penetrating placenta accreta(n=88).Baseline information anesthesia plan selection,intraoperative related indicators,anesthesia management and maternal and infant outcomes in each groupwere compared.Results The rate of no cesarean section in the penetrating group(4.55%)was lower than that in the implantation group(33.00%)and the adhesion group(54.46%),and the rate of 1 cesarean section(78.41%)was higher than that in the implantation group(55.00%)and adhesions Group(38.39%),the difference was statistically significant(P<0.05).The rate of choosing intraspinal anesthesia in the penetrating group(9.09%)was significantly lower than that of the implantation group and adhesion group(80.00%,93.75%),and the rate of choosing general anesthesia in the penetrating group(68.18%)was significantly higher than that of the implantation group and adhesion group(12.00%,5.36%),the rate of transition from intraspinal anesthesia to general anesthesia in the penetrating group(22.73%)was significantly higher than that of the implantation group and adhesion group(8.00%,0.89%),the differences were statistically significant(P<0.05).The greater the degree of placenta implantation,the longer the operation time,the time of anesthesia,the time from surgery to the delivery of the fetus,the hospitalization time,the more bleeding,the higher the rate of recovery autologous blood transfusion,insulation measures,maternal hysterectomy,and ICU treatment,the lower the Apgar score of newborns at 1 min,the differences were statistically significant(P<0.05).Conclusion For patients with low degree of placenta accreta,the first choice of anesthesia is intraspinal anesthesia.If preoperative examination of patients with severe placenta implantation is more likely to change the anesthesia mode during operation,it is necessary to prepare for general anesthesia.