35例妊娠合并血小板减少症患者剖宫产术中连续蛛网膜下腔麻醉观察

发布时间：2018-07-12 10:35

本文选题：妊娠期血小板减少症 + 连续蛛网膜下腔麻醉　；参考：《山东医药》2017年03期

【摘要】：目的观察合并妊娠期血小板减少症的产妇剖宫产术应用连续蛛网膜下腔麻醉的可行性。方法合并妊娠期血小板减少症行剖宫产术分娩的产妇70例,采用随机数字表法分为CSA组、GA组各35例。CSA组手术采用布比卡因连续蛛网膜下腔麻醉,待麻醉平面达到T6开始手术;GA组手术采用丙泊酚、瑞芬太尼、罗库溴铵诱导全身麻醉、气管插管后机械通气。记录产妇术前血小板计数、术中出血量、从手术切皮至胎儿娩出时间(UIDI)。比较两组产妇麻醉前和麻醉后5、10、20、30 min及手术结束时的平均动脉压(MAP)和心率(HR)。比较两组新生儿体质量,出生后1、5、10 min Apgar评分,脐带动脉血血气分析结果。观察产妇有无恶心呕吐、头痛、马尾综合征、术中知晓等情况。结果 CSA组UIDI短于GA组(P0.05)。CSA组麻醉后5 min的MAP低于GA组(P0.05)。两组新生儿出生后1 min Apgar评分均大于5分,GA组6~8分者8例,CSA组为2例,两组相比,P0.05;两组新生儿出生后5、10 min Apgar评分均为9~10分,差异无统计学意义。CSA组发生恶心呕吐4例、头痛1例(术后第3天缓解),GA组分别为5、0例。两组均未发生马尾综合征和术中知晓情况。结论连续蛛网膜下腔麻醉用于妊娠期血小板减少症产妇行剖宫产术安全可行,对胎儿影响小,不良反应较少。
[Abstract]:Objective to observe the feasibility of continuous subarachnoid anesthesia in cesarean section of pregnant women with thrombocytopenia. Methods 70 pregnant women with thrombocytopenia complicating pregnancy undergoing cesarean section were randomly divided into CSA group (n = 35) and CSA group (n = 35). Continuous subarachnoid anesthesia with bupivacaine was used in CSA group. In GA group, propofol, remifentanil and rocuronium were used to induce general anesthesia and mechanical ventilation after tracheal intubation. The platelet count, intraoperative blood loss, and the time from skin incision to fetal delivery (UIDI) were recorded. The mean arterial pressure (map) and heart rate (HR) before and after anesthesia were compared between the two groups. The body weight of newborns, the score of 10 min Apgar and the blood gas analysis of umbilical artery were compared between the two groups. To observe the nausea and vomiting, headache, cauda equina syndrome, intraoperative knowledge and so on. Results the map of CSA group was shorter than GA group (P0.05). The map of CSA group 5 min after anesthesia was lower than that of GA group (P0.05). There were 2 cases in GA group with 6 ~ 8 scores in GA group, 2 cases in group A (P 0.05), 9 ~ 10 min Apgar scores in group A (9 ~ 10 min Apgar) after birth, and 4 cases of nausea and vomiting occurred in group A, the difference was not statistically significant (P > 0.05), and there was no significant difference between the two groups in the score of 1 min Apgar after birth (P < 0.05), the difference was not significant (P > 0.05). There were 5 cases of headache in GA group (3 days after operation). Cauda equina syndrome and intraoperative knowledge were not found in both groups. Conclusion continuous subarachnoid anesthesia is safe and feasible for pregnant women with thrombocytopenia.
【作者单位】：首都医科大学附属北京妇产医院;
【分类号】：R614.4

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