妊娠合并重症肝炎剖宫产术的麻醉处理

目的分析晚期妊娠合并重症肝炎行剖宫产术围麻醉期的麻醉处理。方法我院1990～2004年合并重症肝炎产妇行剖宫产术12例,ASAⅢ～Ⅳ级,按麻醉方式分为两组:全身麻醉组(G组,6例),硬膜外麻醉组(E组,6例)。收集资料包括两组产妇术前一般情况;术中出血量、尿量、输液量、手术时间、胎儿娩出时间;新生儿Apgar评分;两组手术前后肝功能指标的变化;两组凝血物质使用及凝血功能的比较。术后母婴恢复情况。结果两组产妇术前的凝血功能比较,G组Plt值明显小于E组(P<0.05),PT、APTT则大于E组(P<0.05)。两组凝血物质使用无显著性差异。术中出血量、尿量、输液量、手术时间、胎儿娩出时间无显著性差异。两组新生儿Apgar评分无显著性差异。两组术前、术后肝功能指标无显著性差异。结论应根据患者的凝血功能选择麻醉方式。麻醉处理的要点在于维持呼吸循环的稳定,改善凝血功能及尽量应用对肝功能损害少的药物。

The anesthetic management for cesarean section in obstetric patients with severe viral hepatitis

Objective To study anesthetic management for cesarean section in obstetric patients with severe viral hepatitis.Methods Twelve obsstetric patients with severe viral hepatitis for cesarean sections were observed.The patients were divided into two general anesthesia(group G,n=6)and epidural anesthesia(group E,n=6).The information included volume of blood transfusion,blood loss and urine volume,time of operation and fetal disengagement,Apgar score of neonates hepatic function and blood coagulation function.Results Plt of group G was less than that of group E(P<0.05),and PT,APTT of group G were longer than those of group E(P<0.05).Apgar score of neonates and hepatic function of the two groups had no significant differences.Conclusion General anesthesia or epidural anesthesia should be choosed according to coagulation function.The keys of anesthetic administration are to maintain the stabilization of respiratory and circulatory function,to improve the blood coagulation function and to apply some drugs which are less harmful to the liver.