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| 围术期患者因素和麻醉方式对再次剖宫产术中出血风险的影响 |
| Effects of maternity factors and anesthesia methods on the risk of intraoperative hemorrhage for repeat cesarean delivery |
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| DOI：10.12089/jca.2019.11.007 |
| 中文关键词: 再次剖宫产 术中出血 Logistic回归 麻醉方式 |
| 英文关键词: Repeat cesarean delivery Intraoperative hemorrhage Logistic regression Anesthesia method |
| 基金项目:国家重点研发计划(2018YFC0117200) |
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| 中文摘要: |
目的 通过回顾性病例数据分析,探讨围术期患者因素和麻醉方式对再次剖宫产术中出血风险的影响。
方法 通过检索医院电子病历系统,搜集我院2015年10月至2017年10月再次剖宫产产妇2 442例的临床病历资料,年龄20～45岁,BMI 18～40 kg/m2,ASA Ⅰ—Ⅳ级。剖宫产常规采用椎管内麻醉,全麻仅用于患者强烈要求、椎管内麻醉禁忌或失败等情况。根据术中出血标准分为明显出血组(MH组,n=494)和非明显出血组(NMH组,n=1948)。记录产妇的术前、术中和术后的资料。应用Logistic回归分析筛选术中出血的危险因素。采用倾向性匹配分析比较全麻组(GA组,n=141)与非全麻组(NGA组,n=141)术中明显出血发生率、新生儿窒息和住院时间。
结果 MH组的术中出血量明显大于NMH组(P < 0.05)。Logistic回归结果显示再次剖宫产术中出血的危险因素包括:前置胎盘(OR=38.269,95％CI 15.970～91.706,P < 0.001),宫缩乏力(OR=10.047,95％CI6.155～16.399,P < 0.001),胎盘粘连(OR=5.045,95％CI 3.146～8.089,P < 0.001),全麻(OR=2.922,95％CI 1.521～5.614,参考组:非全麻,P < 0.001)等。倾向性匹配结果显示,GA组术中明显出血发生率明显高于NGA组(P < 0.05), 1 min新生儿窒息率明显明显高于NGA组(P < 0.05),住院时间明显长于NGA组(P < 0.05)。
结论 再次剖宫产术中出血的风险因素包括前置胎盘、宫缩乏力、胎盘粘连、全麻等。全麻与非全麻比较,可增加术中出血风险和新生儿窒息发生率,延长住院时间。 |
| 英文摘要: |
Ojective To identify the effects of maternity factors and anesthesia methods on the risk of intraoperative hemorrhage for repeat cesarean delivery by retrospectively analysis based on medical records.
Methods By searching the electronic medical record system, the clinical medical records of 2 442 women undergoing repeat cesarean deliveryin our hospital from October 2015 to October 2017 were collected.Inclusion criteria: 20-45 years old, BMI 18-40 kg/m2, ASA physical status Ⅰ-Ⅳ. Intraspinal anesthesia was routinely used in cesarean section, general anaesthesia was virtually exclusively used in emergency situations, or when intraspinal anaesthesia techniques had failed or were contraindicated. According to the criteria of intraoperative hemorrhage, patients were divided into marked hemorrhage group (group MH, n = 494) and non-marked hemorrhage group (group NMH, n=1 948). Preoperative, intraoperative and postoperative data of parturients were recorded. Logistic regression analysis was performed to identify the risk factors for intraoperative hemorrhage, and propensity score matching analysis to compare the incidence of marked intraoperative hemorrhage and neonatal asphyxia, and hospital stay between general anesthesia group(group GA, n = 141) and non-general anesthesia group(group NGA, n = 141).
Results Hemorrhage during surgery in group MH was significantly larger than group NMH(P < 0.05). The logistic regression results showed that the risk factors of intraoperative hemorrhage for repeat cesarean delivery were placenta previa (OR = 38.269, 95％ CI 15.970-91.706, P < 0.001), uterine atony (OR = 10.047, 95％ CI 6.155-16.399, P < 0.001), placental adhesion(OR = 5.045, 95％ CI 3.146-8.089, P < 0.001), general anesthesia (OR = 2.922, 95％ CI 1.521-5.614, reference group: non-general anesthesia, P < 0.001), and etc. The propensity score matching analysis showed that patients in group GA had higher morbidity of marked intraoperative hemorrhage (P < 0.05), higher incidence of neonatal asphyxia at 1 minutes after delivery (P < 0.05) and longer hospital stay (P < 0.05) compared to group NGA.
Conclusion Risk factors of intraoperative hemorrhage for repeat cesarean delivery included placenta previa, uterine atony, placental adhesion, general anesthesia, and etc. Compared with non-general anesthesia, general anesthesia could increase the risk of intraoperative hemorrhage, the morbidity of neonatal asphyxia and the hospital stay. |
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