不同麻醉方式在肝炎后肝硬化孕妇剖宫产术中临床效果的比较

发布时间：2018-05-13 09:17

本文选题：肝炎后肝硬化 + 剖宫产　；参考：《临床麻醉学杂志》2017年04期

【摘要】：目的探讨和比较肝炎后肝硬化孕妇剖宫产术中全身麻醉与单次腰麻的临床效果。方法收集2010年6月至2016年6月首都医科大学附属北京地坛医院住院分娩的肝炎后肝硬化孕妇相关资料35例,肝硬化代偿期26例,失代偿期9例,年龄24~45岁,体重55~98kg,ASAⅡ或Ⅲ级。麻醉方式包括全身麻醉和单次腰麻,PLT低于50×109/L为全身麻醉(A组,n=15),静注丙泊酚1.5mg/kg,胎儿取出断脐后,行气管插管,术中持续泵入瑞芬太尼0.2μg·kg~(-1)·min~(-1)和TCI丙泊酚维持麻醉至手术结束;PLT高于50×10~9/L为单次腰麻(B组,n=20),选左侧卧位经L3~4间隙穿刺,见脑脊液后注入罗哌卡因10~15mg,10s注完。比较两组孕妇术前基本情况、术中出血量、手术时间、Apgar评分及不同麻醉方式下机体肝功、凝血功能等指标变化。非条件Logistic回归模型分析术后肝功能变化的影响因素。结果 A、B两组术中出血量、手术时间、Apgar评分、术后住院天数等情况差异无统计学意义。与术前比较,A组白蛋白(ALB)明显升高(P0.05);B组孕妇丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)明显升高(P0.01)。非条件Logistic回归分析显示,麻醉方式是术后总胆红素(TBIL)升高的危险因素(OR=12.04,95%CI 1.14~127.45),单次腰麻后TBIL升高的可能性明显大于全身麻醉。结论肝炎后肝硬化孕妇剖宫产术中,单次腰麻对肝功能的影响可能较全身麻醉显著。
[Abstract]:Objective to investigate and compare the clinical effects of general anesthesia and single lumbar anesthesia in caesarean section of pregnant women with post hepatitis cirrhosis. Methods 35 cases of pregnant women with post hepatitis cirrhosis in the Beijing Ditan Hospital of Capital Medical University from June 2010 to June 2016 were collected, 26 cases of decompensated cirrhosis, 9 cases of decompensated period, age 24~45 years, body 55~98kg, ASA II, or class III. The anesthetic methods included general anesthesia and single lumbar anesthesia, PLT below 50 x 109/L for general anesthesia (group A, n=15), intravenous propofol 1.5mg/kg, fetal removal of umbilical cord, tracheal intubation, and continuous infusion of remifentanil 0.2 mu g. Kg~ (-1) min~ (-1) and propofol to the end of the operation; higher than 50 * For the single lumbar anesthesia (group B, n=20), the left lateral position was selected by L3~4 clearance, and the cerebrospinal fluid was injected with ropivacaine 10~15mg, and 10s was injected. The preoperative basic conditions, the amount of bleeding, the operation time, the operation time, the Apgar score, the liver function and the coagulation function in the two groups were compared. The non conditional Logistic regression model was used to analyze the postoperative liver. There was no significant difference in the amount of bleeding, operation time, Apgar score, and the number of days after operation in group A, B two. Compared with preoperative, the albumin (ALB) in group A was significantly higher (P0.05), and in B group, the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were significantly increased (P0.01). Non conditional Lo. Gistic regression analysis showed that the mode of anesthesia was a risk factor for the increase of total bilirubin (TBIL) after operation (OR=12.04,95%CI 1.14~127.45). The possibility of increasing TBIL after single lumbar anesthesia was significantly greater than that of general anesthesia. Conclusion the effect of single lumbar anesthesia on liver function in caesarean section of pregnant women with posthepatitic cirrhosis may be more significant than that of general anesthesia.

【作者单位】：首都医科大学附属北京地坛医院妇产科;首都医科大学附属北京地坛医院麻醉科;
【分类号】：R614

【相似文献】