合并胎盘植入行剖宫产术患者的麻醉方式选择

目的：研究合并胎盘植入行剖宫产术患者的麻醉方式选择。方法： 通过国际疾病分类（International Classification of Diseases，ICD） 9查询2008年至2013年北京大学第三医院出院诊断包含“胎盘植入”的病例，剔除自然产、剖宫取胎及非我院首诊病例，共有96例纳入到本次研究中。根据植入程度分为粘连型、植入型、穿透型3组，分析手术开始至胎儿娩出时间、麻醉方式选择。结果： 96例患者中粘连型49例、植入型33例、穿透型14例，粘连组、植入组、穿透组的手术开始至胎儿娩出的时间平均分别为（6.7±3.0） min、（7.2±4.6） min、（11.9±4.9） min，穿透组与粘连组、植入组比较差异有统计学意义（P＜0.05）。不同植入程度麻醉方式选择差异有统计学意义（P＜0.001）， 其中粘连组45例（91.8%）患者行椎管内麻醉，2例（4.1%）行全身麻醉，2例（4.1%）先行椎管内麻醉后术中转为全身麻醉；植入组22例（66.7%）患者行椎管内麻醉，4例（12.1%）行全身麻醉，7例（21.2%）先行椎管内麻醉后术中转为全身麻醉；穿透组有2例（14.3%）患者行椎管内麻醉，2例（14.3%）行全身麻醉，10例（71.4%）先行椎管内麻醉，后术中转为全身麻醉。结论： 椎管内麻醉可作为合并胎盘植入行剖宫产术麻醉的首选方法，若术前提示穿透型胎盘植入，需做好全身麻醉的准备。

Anesthetic choice for patients undergoing cesarean section complicated with placenta implantation

Objective:To investigate the anesthetic choice for patients undergoing cesarean section complicated with placenta implantation.Methods: A retrospective case review of the patients with placenta implantation between 2008 and 2013 at Peking University Third Hospital was conducted in the International Classification of Diseases (ICD)-9 codes,excluding natural birth and not first diagnosed in our hospital,a total of 96 cases were incorporated into this study.According to the degree of implantation,they were divided into three groups: accreta group,increta group and percreta group.We analyzed the time from the start of surgery to baby delivery and the anesthetic technique.Results: The accreta group included 49 cases,the increta group 33 cases,and the percreta group 14 cases.The average time from the start of surgery to fetus delivery in the three groups were (6.7±3.0) min,(7.2±4.6) min,and (11.9±4.9) min,and the percreta group was significantly different from the accreta group and the increta group (P<0.05).There were significant differences among the three groups in anesthetic choices (P<0.001): in the accreta group,45 cases (91.8％) underwent spinal anesthesia,2 cases (4.1％) underwent general anesthesia,and 2 cases (4.1％) were converted to general anesthesia after spinal anesthesia during the operation;in the increta group,22 cases (66.7％) underwent spinal anesthesia,4 cases (12.1％) underwent general anesthesia,and 7 cases(21.2％) were converted to general anesthesia after spinal anesthesia;in the percreta group,2 cases (14.3％) underwent spinal anesthesia,2 cases (14.3％) underwent general anesthesia,and 10 cases (71.4％) were converted to general anesthesia after spinal anesthesia.Conclusion: Spinal anesthesia can be used as the first choice of cesarean section complicated with placenta implantation and general anesthesia should be considered in placenta percreta.