合并胎盘植入行剖宫产术患者的麻醉方式选择

发布时间：2018-02-17 02:55

本文关键词： 胎盘植入剖宫产术麻醉　出处：《北京大学学报(医学版)》2017年02期 　论文类型：期刊论文

【摘要】：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(P0.05)。不同植入程度麻醉方式选择差异有统计学意义(P0.001),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。
[Abstract]:Objective: to study the anesthetic choice of patients undergoing caesarean section with placenta accreta. Methods: from 2008 to 2013, the patients who were discharged from the third Hospital of Peking University who were diagnosed as "placenta accreta" were investigated by the International Classification of Diseases (ICD- 9). A total of 96 cases were included in this study. According to the degree of implantation, 96 cases were divided into three groups: adhesive type, implantable type and penetrating type. The time from the beginning of operation to the delivery of the fetus was analyzed. Results in 96 cases, 49 cases of adherent type, 33 cases of implantable type, 14 cases of penetrating type, the average time from the beginning of operation to fetal delivery in adhesive group, implant group, penetrating group and penetrating group were 6.7 卤3.0 min, 7.2 卤4.6 min, 11.9 卤4.9 min, respectively, and the mean time between penetrating group and adhesion group was 11.9 卤4.9 min. There were significant differences between the implanted group and the other two groups (P 0.05). There were significant differences in the choice of anesthesia methods among the different implantation degrees (45 cases in the adhesion group were treated with intraspinal anesthesia (n = 2) and 4. 1%) (2 cases were treated with general anesthesia (n = 2) after intraspinal anaesthesia) after intraspinal anesthesia (n = 45, n = 45, n = 45, n = 45, n = 91.8). Conversion to general anesthesia during operation; In the implantation group, 22 patients were treated with intraspinal anesthesia (n = 22) and 4 patients received intraspinal anesthesia (n = 4) and 7 patients underwent general anesthesia (n = 7). In the penetrating group, 2 patients were treated with intraspinal anesthesia (n = 2, n = 2) and 10 patients received general anesthesia (n = 10, n = 71.4). Conclusion: spinal canal anesthesia can be used as the first choice for caesarean section anesthesia with placenta accreta. If we suggest penetrating placenta accreta before operation, we should prepare for general anesthesia.
【作者单位】：北京大学第三医院麻醉科;
【分类号】：R614

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