重度妊高症剖宫产麻醉130例分析

目的探讨重度妊高症患者行剖宫产术的围麻醉期处理及其对母婴的影响。方法回顾分析我院2006年1月～2008年12月3年期间收治的130例重度妊高症剖宫产患者病例资料。结果130例剖宫产麻醉中,21例患者采用硬膜外麻醉,49例采用腰硬联合麻醉,60例患者采用了全身麻醉的方式。入ICU及回病房比例硬外组(77%,23%),腰硬联合组(34%,66%),全麻组(70%,30%)。三组患者的凝血酶原时间(PT)、部分凝血活酶时间(APTT)、血红蛋白(Hb)及术前MAP无显著差异(P>0.05),仅血小板计数(Plt)在GA组明显低于硬膜外麻醉组与腰硬联合麻醉组(P<0.05)。不同麻醉方式的患者术中母婴情况比较:新生儿1min及5min Apgar评分小于7分占百分率全麻组明显低于腰硬联合麻醉,而腰硬联合麻醉组与硬膜外麻醉组无差别。三组患者的术中最低血压、手术时间、出血量、术中肺水肿发生率、术中输入胶体液及晶体液均无显著性差异(P>0.05)。三组患者术后入住ICU比较:腰硬联合麻醉组(35%)低于全麻组(73%)及硬膜外麻醉(81%)。结论充分的术前准备,包括解痉、降压;麻醉中加强监测及调控,加强术中液体管理,对防治母婴严重并发症具有重要意义。

Clinical Analysis of 130 Cases with Severe Pregnancy Induced Hypertension Syndrome in Cesarean Section Anesthesia

Objective To discuss the anesthesia management for the patients with severe pregnancy induced hypertension syndrome and to observe the influence of maternal and neonatal outcome during cesarean section. Methods Retrospectively analyzing the datas of 130 cases with severe pregnancy-induced hypertension syndrome who underwent cesarean section in my hospital from January 2006 to December 2008. Results Study groups included 21 patients receiving epidural anesthesia(EA),49 patients receiving combined spinal-epidural anesthesia (CSEA) and 60 patients receiving general anesthesia (GA). The ratio of entering ICU and backing to the ward after cesarean section was 77% and 23% respectively in group EA,34% and 66% respectively in group CSEA,70% and 30% respectively in group GA. In three groups,there were no significant differences in PT,APTT,Hb and MAP before operation (P >0.05). PLT in group GA was significantly lower than in group EA and in group CSEA (P <0.05). The effect of different anesthesia methods on parturient and neonate was found:the incidence of Apgar scores lower than 7 at 1 min and at 5 min,were lower in group GA than in group CSEA (P <0.05). There was no significant difference between group CSEA and group EA for Apgar scores (P >0.05). In three group,there were no significant differences in the lowest BP,operation duration,incidence of pulmonary edema,blood loss,intraoperative crystalloid administration,and intraoperative colloid administration (P >0.05). The ratio of entering ICU was lower in group CSEA than in group EA and in group GA (P <0.05). Conclusion Preoperative preparation which includes spasmolysis,antihypertensive treatment; strengthening intraoperative monitoring,and intraoperative flu id administration,are important measures to prevent and treat the severe complications on parturient and neonate.