摘要
目的:探讨硬膜外镇痛时间对中转剖宫产麻醉方式选择和效果影响。方法:回顾性收集2018年8月-2022年8月在本院产科实施硬膜外镇痛分娩并中转剖宫产的742例产妇临床资料,按照剖宫产麻醉方式分别纳入硬膜外麻醉组和脊髓麻醉组。多因素logistic回归分析麻醉方式的影响因素,建立受试者工作特征曲线(ROC),依据约登指数确定镇痛时间临界值,依据临界值将孕妇分为硬膜外镇痛长程组和短程组,比较两组麻醉效果等指标。结果:742例剖宫产行硬膜外麻醉566例(76.3%)、脊髓麻醉176例(23.7%);多因素logistic回归分析显示,硬膜外镇痛时间延长、导管移位、宫口开大均是脊髓麻醉的有利因素(P<0.05),术前人工破膜是脊髓麻醉的不利因素(P<0.05);ROC结果显示,硬膜外镇痛时间最佳临界值9.53h,敏感性0.588,特异性0.895,长程组接受脊髓麻醉的概率为短程组的2.794倍,长程组术中低血压发生几率(31.5%)高于短程组(21.0%)(P<0.05)。结论:硬膜外镇痛中转剖宫产麻醉方式以硬膜外麻醉和脊髓麻醉为主,硬膜外镇痛时间是麻醉方式的重要影响因素,对于镇痛时间≥9.53h的中转剖宫产孕妇脊髓麻醉机率更高,但需注意预防术中低血压的发生。
Objective: To investigate the influence of the duration of epidural labor analgesia of women with converted to cesarean section on the choice and effect of their anesthesia mode. Methods: The clinical data of 742 pregnant women with epidural labor analgesia and converted to cesarean section from August 2018 to August 2022 were collected retrospectively. These women were divided into group A(women with epidural anesthesia during cesarean section) and group B(women with spinal anesthesia during cesarean section) according to the anesthesia mode for cesarean section. Multivariate logistic regression analysis was used to explore the influencing factors of the anesthesia mode during cesarean section, the receiver operating characteristic(ROC) curve was established. The critical value of analgesia duration of the women was determined by Yoden index, and the women in group A were divided into group A1(women with long duration of epidural analgesia) and group B(women with short duration of epidural analgesia) according to the critical value. The anesthetic effect and other indexes of the women were compared between the two groups. Results: There were 566(76.3%) women in group A and 176(23.7%) women in group B. Multiple logistic regression analysis showed that the prolonged epidural analgesia, the catheter displacement, and the uterine orifice opened wide of the women were the favorable factors of their epidural anesthesia(P<0.05), while the preoperative artificial rupture of membranes of the women was the unfavorable factors(P<0.05). ROC results showed that the optimal threshold of the epidural analgesia duration was 9.53h, and the sensitivity and the specificity of which were 0.588 and 0.895. The probability of receiving spinal anesthesia of the women in group A1was 2.794times of that of the women in group A2,and the incidence of intraoperative hypotension(31.5%)of the women in group A1was significantly higher than that(21.0%)of the women in group A2(P<0.05).Conclusion:The main anesthesia mode of the women who were converted to cesarean section during epidural labor analgesia of tried vaginal delivery were the epidural analgesia and spinal anesthesia.The duration of epidural analgesia was the important factor affecting the anesthesia mode of caesarean section.The probability of spinal anesthesia during caesarean section of the women with labor analgesia duration≥9.53h who were converted to caesarean section was significantly higher,but the prevention of intraoperative hypotension of the women should be paid attention to.
作者
林晓钦
朱昱
卓庆亮
陈文斌
LIN Xiaoqin;ZHU Yu;ZHUO Qingliang;CHEN Wenbin(Ningde Municipal Hospital Affiliated to NingDe Normal University,Ningde,Fujian Province,352100)
出处
《中国计划生育学杂志》
2023年第2期474-479,共6页
Chinese Journal of Family Planning
关键词
镇痛分娩
中转剖宫产
麻醉方式
硬膜外镇痛时间
脊髓麻醉
影响因素
Labor analgesia
Converted to cesarean section
Anesthesia mode
Epidural analgesia duration
Spinal anesthesia
Influence factor
