[1]高宪,朱圆,熊亚,等.计划性全身麻醉改善前置胎盘产妇剖宫产手术预后的随机对照研究[J].第三军医大学学报,2019,41(07):684-690.
 GAO Xian,ZHU Yuan,XIONG Ya,et al.Planned combined neuraxial anethesia improves prognosis for parturients diagnosed pernicious placenta previa undergoing caesarean delivery: a prospective randomised controlled trial[J].J Third Mil Med Univ,2019,41(07):684-690.
点击复制

计划性全身麻醉改善前置胎盘产妇剖宫产手术预后的随机对照研究(/HTML )
分享到:

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第07期
页码:
684-690
栏目:
临床医学
出版日期:
2019-04-15

文章信息/Info

Title:
Planned combined neuraxial anethesia improves prognosis for parturients diagnosed pernicious placenta previa undergoing caesarean delivery: a prospective randomised controlled trial
作者:
高宪朱圆熊亚杨贞王丹常青鲁开智甯交琳
陆军军医大学(第三军医大学)第一附属医院:麻醉科,妇产科
Author(s):
GAO Xian ZHU Yuan XIONG Ya YANG Zhen WANG DanCHANG Qing LU Kaizhi NING Jiaolin

Department of Anaesthesiology, Department of Gynaecology and Obstetrics, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
 

关键词:
前置胎盘全身麻醉腰硬联合麻醉产后出血
Keywords:
placenta praevia general anesthesia combined spinalepidural anesthesiapostpartum haemorrhage  
分类号:
R614.2; R614.4; R719.8
文献标志码:
A
摘要:

目的 比较腰硬联合麻醉(combined spinalepidural anesthesia,CSA)(含非计划性全身麻醉)与CSA联合计划性全身麻醉对凶险性前置胎盘产妇接受剖宫产手术术中效果及预后的影响。方法 纳入2015年4月至2017年12月孕28周后于本院超声科诊断为凶险性前置胎盘准备行剖宫产术的产妇106例。采用随机数字表法将产妇分为2组(n=53):①腰硬联合+计划性全身麻醉(spinal+general anesthesia,SGA)组,产妇在腰硬联合麻醉下实施剖宫产、待胎儿取出夹闭脐带后实施全麻;②CSA组:产妇接受常规腰硬联合麻醉。比较两组术中出血量、手术时间、术后转入ICU率、血流动力学参数、血制品的输入量、术后母乳喂养情况以及术后产妇抑郁症的发生率等指标。结果 ①CSA组因术中不能耐受转为全麻者(CSA-GA组)18例,CSA-GA组产妇术中失血量[(2 994±1 895) vs (1 181±504) mL]及失血量>2 000 mL(12 vs 6例)、术后转入ICU(10 vs 2例)、产后30 d抑郁(16 vs 22例)的发生率高于仅接受常规腰硬联合麻醉(CSAonly)组(P均<0.01)。②SGA组的产妇失血量>2 000 mL(8 vs 18例,P<0.05)、术后转入ICU(3 vs 12例,P<0.05)以及产后30 d抑郁发生比例(11/53 vs 38/53,P<0.01)明显低于CSA组。结论 接受剖宫产的凶险性前置胎盘产妇,与非计划性全身麻醉比较,计划全身麻醉可减少术中出血量、降低术中大出血发生率和ICU入住率;计划性全身麻醉可通过改善手术条件降低产后抑郁的发生率。

Abstract:

Objective To evaluate the clinical effectiveness of combined spinal-epidural anesthesia (including unplanned general anesthesia) and planned general anesthesia combined spinal epidural anesthesia for parturients diagnosed with pernicious placenta previa (PPP) undergoing caesarean section.  Methods A total of 106 parturients (28 weeks of gestation) diagnosed with PPP by ultrasonography in our hospital during April 2015 and December 2017 were eligible to participate in the study. They were randomly allocated to SGA and CSA groups (n=53). The patients in the SGA group received combined spinal-epidural anesthesia, and general anesthesia was induced after clamping of the umbilical cord. For those in the CSA group, they were given conventional combined spinal epidural anesthesia. The intraoperative bleeding amount, operation time, proportion of ICU admission, hemodynamic parameters, amounts of blood products administered, condition of breastfeeding and incidence of postpartum depression measured by the Edinburgh depression scale were compared between the 2 groups.  Results ① There were 18 parturients in the CSA group who had to being converted to general anaesthesia due to uncomfortableness during surgery. This group of patients had larger amount of intraoperative bleeding (2 994±1 895 vs 1 181±504 mL), higher ratio of those with the bleeding volume over 2 000 mL (12 vs 6), higher proportion of ICU admission (10 vs 2), and higher incidence of postpartum depression in 30 d after delivery (22 vs 16) when compared to those in the CSA group but not with the conversion (all P<0.01). ② The numbers of the patients with bleeding volume >2 000 mL (8 vs 18, P<0.05), of ICU admission (3 vs 12, P<0.05) and the incidence of postpartum depression (11/53 vs 38/53, P<0.01) were significantly lower in the SGA group than the CSA group. Conclusion For the PPP parturients undergoing caesarean section, planned general anaesthesia after delivery of baby is superior to conversion from spinal to general anaesthesia in decreasing intraoperative blood loss, and reducing rates of massive bleeding and ICU admissions. What’s more, the anaesthesia plan also decreases the incidence of postpartum depression by providing optimal operating conditions.

参考文献/References:

[1]CHATTOPADHYAY S K, KHARIF H, SHERBEENI M M. Placenta praevia and accreta after previous caesarean section[J]. Eur J Obstet Gynecol Reprod Biol, 1993, 52(3): 151-156. DOI:10.1016/0028-2243(93)90064j.
[2]DAI M J, JIN G X, LIN J H, et al. Pre-cesarean prophylactic balloon placement in the internal iliac artery to prevent postpartum hemorrhage among women with pernicious placenta previa[J]. Int J Gynecol Obstet, 2018, 142(3): 315-320. DOI:10.1002/ijgo.12559.
[3]严小丽,陈诚,常青,等.凶险性前置胎盘20例临床分析[J].实用妇产科杂志,2013,29(9):704-707.DOI:10.3969/j.issn.1003-6946.2013.09.022.
YAN X L, CHEN C, CHANG Q et al.Clinical analysis of 20 cases of pernicious placenta previa[J]. J Pract Obstet Gynecol, 2013,29(9):704-707.DOI:10.3969/j.issn.10036946.2013.09.022.
[4]MATSUDA Y,HAYASHI K,SHIOZAKI A, et al. Comparison of risk factors for placental abruption and placenta previa: case-cohort study[J]. J Obstet Gynaecol Res, 2011,37(6):538-546. DOI:10.1111/j.14470756.2010.01408.x.
[5]YANG Q Y, WEN S W, PHILLIPS K, et al. Comparison of maternal risk factors between placental abruption and placenta previa[J]. Am J Perinatol, 2009, 26(4): 279-286. DOI:10.1055/s00281103156.
[6]YANG Q, WEN S W, OPPENHEIMER L, et al. Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy[J]. BJOG, 2007, 114(5): 609-613. DOI:10.1111/j.14710528.2007.01295.x.
[7]AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS. ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 76, october 2006: postpartum hemorrhage[J]. Obstet Gynecol, 2006, 108(4): 1039-1047.
[8]BONNER S M, HAYNES S R, RYALL D. The anaesthetic management of Caesarean section for placenta praevia: a questionnaire survey[J]. Anaesthesia, 1995, 50(11): 992-994.
[9]PAREKH N, HUSAINI S W, RUSSELL I F. Caesarean section for placenta praevia: a retrospective study of anaesthetic management[J]. Br J Anaesth, 2000, 84(6): 725-730.
[10]CHANG C C, WANG I T, CHEN Y H, et al. Anesthetic management as a risk factor for postpartum hemorrhage after cesarean deliveries[J]. Am J Obstet Gynecol, 2011, 205(5): 462.e1-462.e7. DOI:10.1016/j.ajog.2011.06.068.
[11]LILKER S J, MEYER R A, DOWNEY K N, et al. Anesthetic considerations for placenta accreta[J]. Int J Obstet Anesth, 2011, 20(4): 288-292. DOI:10.1016/j.ijoa.2011.06.001.
[12]MARKLEY J C, FARBER M K, PERLMAN N C, et al. Neuraxial anesthesia during cesarean delivery for placenta previa with suspected morbidly adherent placenta: a retrospective analysis[J]. Anesth Analg, 2018, 127(4): 930-938. DOI:10.1213/ANE.0000000000003314.
[13]PURVA M, RUSSELL I, KINSELLA M. Conversion from regional to general anaesthesia for caesarean section: are we meeting the standards?[J]. Anaesthesia, 2012, 67(11): 1278-1279. DOI:10.1111/anae.12021.
[14]RIVEROSPEREZ E, WOOD C. Retrospective analysis of obstetric and anesthetic management of patients with placenta accreta spectrum disorders[J]. Int J Gynaecol Obstet, 2018, 140(3): 370-374. DOI:10.1002/ijgo.12366.
[15]MUOZ L A, MENDOZA G J, GOMEZ M, et al. Anesthetic management of placenta accreta in a low-resource setting: a case series[J]. Int J Obstet Anesth, 2015, 24(4): 329-334. DOI:10.1016/j.ijoa.2015.05.005.
[16]MARTINI C H, BOON M, BEVERS R F, et al. Evaluation of surgical conditions during laparoscopic surgery in patients with moderate vs deep neuromuscular block[J]. Br J Anaesth, 2014, 112(3): 498-505. DOI:10.1093/bja/aet377.
[17]BARRIO J, ERRANDO C L, SAN MIGUEL G, et al. Effect of depth of neuromuscular blockade on the abdominal space during pneumoperitoneum establishment in laparoscopic surgery[J]. J Clini Anesth, 2016,34:197-203. DOI: 10.1016/j.jclinane.2016.04.017.
[18]HONG J Y, JEE Y S, YOON H J, et al. Comparison of general and epidural anesthesia in elective cesarean section for placenta previa totalis: maternal hemodynamics, blood loss and neonatal outcome[J]. Int J Obstet Anesth, 2003, 12(1): 12-16. DOI:10.1016/s0959-289x(02)00183-8.
[19]JAMES F M III, CRAWFORD J S, HOPKINSON R, et al. A comparison of general anesthesia and lumbar epidural analgesia for elective cesarean section[J]. Anesth Analg, 1977, 56(2): 228-235. DOI:10.1213/00000539-197703000-00014.
[20]FRLICH M A, BURCHFIELD D J, EULIANO T, et al. A single dose of fentanyl and midazolam prior to Cesarean section have no adverse neontal effects[J]. Can J Anaesth, 2006, 53(1): 79-85. DOI:10.1007/bf03021531.
)

相似文献/References:

[1]龚涛武,朱昭琼,郑雪,等.不同全身麻醉方法对腹腔镜胆囊切除术后早期认知功能的影响[J].第三军医大学学报,2013,35(01):50.
 Gong Taowu,Zhu Zhaoqiong,Zheng Xue,et al.Effect of different general anesthesia on early postoperative cognitive function of patients undergoing laparoscopic cholecystectomy[J].J Third Mil Med Univ,2013,35(07):50.
[2]莫怀忠,邹小华,胡晓,等.全麻下患者术中知晓的临床分析[J].第三军医大学学报,2008,30(16):1580.
[3]张海山.盐酸右美托咪啶用于围术期镇静及预防气管插管反应的临床研究[J].第三军医大学学报,2011,33(21):2319.
[4]张海山.全麻复合胸段硬膜外阻滞对气管内插管应激反应的影响[J].第三军医大学学报,2004,26(14):0.[doi:10.16016/j.1000-5404.2004.14.038 ]
[5]张铭,李勇帅,崔剑,等.侧卧位病人硬膜外改全麻应用喉罩2例报道[J].第三军医大学学报,2002,24(03):0.[doi:10.16016/j.1000-5404.2002.03.039 ]
[6]曲彦亮,申恒花,温宝磊,等.双侧腋路臂丛神经阻滞用于双上肢显微外科术中的探索研究[J].第三军医大学学报,2016,38(22):2457.
 Qu Yanliang,Shen Henghua,Wen Baolei,et al.Anesthetic efficacy and safety of bilateral axillary brachial plexus block in microsurgery for bilateral upper limbs[J].J Third Mil Med Univ,2016,38(07):2457.
[7]吕锐,高静,杨从文,等.新型国产BR850电子挥发罐监测七氟烷消耗量液态体积的可行性研究[J].第三军医大学学报,2017,39(22):2195.
 LYU Rui,GAO Jing,YANG Congwen,et al.Feasibility of monitoring liquid volume of sevoflurane consumption using a new model (BR850) of vaporizer with electronic liquid level sensor[J].J Third Mil Med Univ,2017,39(07):2195.

更新日期/Last Update: 2019-04-05