腰—硬膜外联合麻醉下剖宫产产妇吸入性肺炎的发生情况

发布时间：2018-03-12 14:24

  本文选题：剖宫产　切入点：吸入性肺炎　出处：《浙江大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的： 估计采用腰硬联合麻醉剖宫产产妇术后吸入性肺炎的发病率,同时分析剖宫产产妇术后发生吸入性肺炎的预后情况及预防措施。 方法： 连续选取腰硬联合麻醉剖宫产产妇117名。排除标准：术前存在咳嗽、血象增高和(或)发热患者。术后第1天行胸部x线及血常规检查,观察记录咳嗽、气急、胸闷等临床症状。吸入性肺炎的诊断是基于术后第一天胸部x线影像表现,辅以咳嗽、气急、胸闷等临床症状及肺部听诊,血常规检查。至少通过一名有经验的临床医师及一名有经验的放射科医师进行诊断。腰硬联合麻醉均采用罗哌卡因(规格：0.75%10ml/支)10-15mg腰麻基础上,硬膜外置管加用罗哌卡因(45mg以内)或左布比卡因(100mg以内)。除择期手术产妇术前予以8小时内禁食预防肺吸入外,没有采取其他预防措施如制酸剂使用等。 结果： 117例患者中11例诊断为吸入性肺炎,7例诊断为疑似吸入性肺炎。吸入性肺炎的发生率为9.4-15.4%。11例确诊病例中有临床阳性症状者仅4例：1例表现为气急、发热(39℃),肺部听诊右下肺少许湿罗音,1例轻度胸闷不适,1例咳嗽,另有1例仅表现为中度发热(38～38.5℃)；7例可疑病例有阳性症状者仅2例,1例表现为咳嗽,1例仅为中度发热(38～38.5℃)。99例肺部X线检查正常者中仅1例为轻度咳嗽。11例确诊吸入性肺炎的患者术后第一天血象异常者(白细胞10×109/L及中性粒比值0.7)6例,7例疑似吸入性肺炎患者中血象异常者3例；99例肺部X线检查正常者术后第1天血象异常者41例。与99例肺部X线检查正常者进行统计学比较,确诊及疑似吸入性肺炎患者术后第1天血象异常的发生率、白细胞及中性粒细胞比值均无统计学意义。11例确诊患者中的4例及7例疑似患者中的2例进行了细菌培养,其中确诊患者中的1例阳性,为非耐药肺炎克雷伯菌亚种。肺部X线检查正常者术后住院时间为(4.9±0.4)d,确诊及疑似吸入性肺炎患者术后住院时间为(6.5±1.8)d,两者进行统计学比较有显著差异(P0.01)。吸入性肺炎患者中一例患者住院1周后呼吸道症状未控制的情况下签字出院,出院后3天因呼吸道症状及发热表现再次入院,治疗1周后好转出院。没有产妇死亡。 结论： 在通过胸部X线诊断吸入性肺炎的基础上我们研究腰硬联合麻醉下剖宫产产妇吸入性肺炎的发生率为9.4-15.4%,远高于我们过去的一些认识。剖宫产产妇术后发生吸入性肺炎的患者术后住院时间较未发生吸入性肺炎者明显延长。我们有必要选择除外增加使用区域麻醉的其他预防措施降低发病率。
[Abstract]:Objective:. To estimate the incidence of aspiration pneumonia after cesarean section under combined spinal-epidural anesthesia, and to analyze the prognosis and preventive measures of aspiration pneumonia after cesarean section. Methods:. 117 cases of cesarean section under combined spinal-epidural anesthesia were selected continuously. Exclusion criteria: patients with cough, hyperhaematology and / or fever before operation. Chest X-ray and routine blood examination were performed on the first day after operation. Cough was observed and recorded. Chest tightness and other clinical symptoms. The diagnosis of aspiration pneumonia is based on chest X-ray findings on the first day after operation, supplemented by clinical symptoms such as cough, shortness of breath, chest tightness, and lung auscultation. Blood routine examination. Diagnosed by at least one experienced clinician and one experienced radiologist. Combined spinal-epidural anesthesia was performed on the basis of ropivacaine (10-15 mg ml/). Epidural catheterization plus ropivacaine (45mg) or levobupivacaine (100mg). No other preventive measures, such as acid preparation, were taken except for prevention of lung inhalation by fasting within 8 hours before elective operation. Results:. Of the 117 patients, 11 cases were diagnosed as inhaled pneumonia and 7 cases were diagnosed as suspected aspiration pneumonia. The incidence of inhaled pneumonia was 9.4-15.4.11 cases of confirmed cases had clinical positive symptoms. Fever was 39 鈩，

本文编号：1601949