|
| 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 |
| Comparison of the clinical effects of general anesthesia and single spinal anesthesia on pregnant women with liver cirrhosis after hepatitis in cesarean section |
| |
| DOI： |
| 中文关键词: 肝炎后肝硬化 剖宫产 全身麻醉 单次腰麻 |
| 英文关键词: Liver cirrhosis after hepatitis Cesarean section General anesthesia Single spinal anesthesia |
| 基金项目: |
|
| 摘要点击次数: 3089 |
| 全文下载次数: 1820 |
| 中文摘要: |
| 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55～98 kg,ASA Ⅱ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1.5 mg/kg,胎儿取出断脐后,行气管插管,术中持续泵入瑞芬太尼0. 2 μg·kg-1·min-1和TCI丙泊酚维持麻醉至手术结束;PLT高于50×109/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10～15 mg,10 s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(P＜0.05);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(P＜0.01)。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。 |
| 英文摘要: |
| Objective To explore and compare the clinical effects of pregnant women with liver cirrhosis after hepatitis in cesarean section between general anesthesia and single spinal anesthesia. Methods Clinical data of pregnant women of 35, including compensated cirrhosis 26 cases,decompensated cirrhosis 9 cases, aged 24-45 years, weighing 55-98 kg, falling into ASA Ⅱ or Ⅲ, were divided into group A (general anesthesia group, n=15) and B (single spinal group, n=20). In patients of group A, propofol were infused at 1.5 mg/kg till the time for fetal delivery, after intubation, followed by infusion of remifentanil at a rate of 0.2 μg·kg-1·min-1 TCL combined with propofol until the end of operation. In group B, the puncture was performed at L3-4 interspace, following by intrathecal injection of ropivacaine 10-15 mg and within 10 seconds. With liver cirrhosis after hepatitis were collected and analyzed, retrospectively. Preoperative general status, blood loss and time of operation, Apgar score of neonates compared and analyzed in groups A and B. And the changes of hepatic function and coagulation function of the body under different anesthesia methods were also studied. The influential factors of postoperative elevation of hepatic function were analyzed by non conditional logistic regression models. Results Blood loss and time of operation, Apgar score of neonates and postoperative hospital stay had no significant differences between the two groups. Postoperative albumin of group A was higher than that of preoperative, with a statistical significance (P＜0.05). Alanine aminotransferase, aspartate aminotransferase of postoperative of group B were increased, with a statistical significance (P＜0.01). Logistic analysis showed that the type of anesthesia was the possible influencing factor of postoperative elevation of total bilirubin (OR=12.04, 95%CI 1.14-127.45). Conclusion The negative effect of single spinal anesthesia on hepatic function more than that of general anesthesia in pregnant women with liver cirrhosis in cesarean section. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
