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肾下腹主动脉球囊临时阻断下行古典式剖宫产的麻醉管理
作者:崔士和  董媛媛 
单位:南京大学医学院附属南京鼓楼医院, 江苏 南京 210008
关键词:麻醉管理 凶险性前置胎盘 古典式剖宫产 腹主动脉球囊阻断 
分类号:R719.81
出版年·卷·期(页码):2021·49·第二期(148-152)
摘要:

目的:总结肾下腹主动脉球囊临时阻断下行古典式剖宫产的麻醉管理经验。方法:回顾性分析2014—2018年于南京鼓楼医院麻醉手术科采用肾下腹主动脉球囊临时阻断法行古典式剖宫产135例产妇的临床资料,包括麻醉方式、手术时间、术中低血压、出血量、输血率、球囊阻断时间、Apgar评分及恶心呕吐、低体温、寒战反应等不良反应的发生情况。根据术中采取的麻醉方式将135例产妇分为腰麻、全麻、腰麻+静脉、腰麻+全麻四组。结果:腰麻+静脉组、腰麻+全麻组手术时间较腰麻组手术时间明显延长(P<0.01)。手术出血量腰麻组显著少于其他三组(P<0.01)。61例(45.2%)产妇术中发生了低血压,82例(60.7%)产妇术中需要输血。球囊阻断时间腰麻组显著低于腰麻+静脉、腰麻+全麻组。术中低体温、寒战及恶心呕吐的总体发生率分别为94(69.6%)、44(32.5%)、15(11.1%),其中腰麻+全麻组寒战反应的发生率显著低于腰麻组。结论:腰麻是肾下腹主动脉球囊临时阻断下行古典式剖宫产术最常用麻醉方式;随着手术时间延长,通常需要采取腰麻+静脉或者腰麻+全麻来完成手术。术中急性失血导致的低血压是该手术常见并发症;术中需有较好的保温意识及保温措施,积极处理寒战、恶心呕吐等不良反应。

Objective:To summarize the experience of anesthesia management of classical abdominal caesarean section with temporary infrarenal aortic balloon blocking.Methods: The clinical data of 135 cases undergoing classical cesarean section with temporary abdominal aorta balloon blocking in the Department of Anesthesiology, Nanjing Drum Tower Hospital from 2014 to 2018 were retrospectively analyzed, including anesthesia methods, operation time, hypotension, bleeding volume, blood transfusion rate, balloon occlusion time, Apgar score, and adverse reactions such as nausea and vomiting, low temperature, chill reaction.135 cases were divided into four groups by anesthesia type:spinal anesthesia, general anesthesia, spinal anesthesia plus monitored anesthesiaand spinal anesthesia plus general anesthesia. Results:The operation time of both the spinal anesthesia plus monitored anesthesia group and spinal anesthesia plus general anesthesia group was significantly longer than that of the spinal anesthesia group(P<0.01). The blood loss in the spinal anesthesia group was significantly less than the other three groups (P<0.01). Hypotension occurred in 61 patients (45.2%) and 82 patients (60.7%) received blood transfusion during the operation. The balloon occlusion time in the spinal anesthesia group was significantly shorter than that of the spinal plus monitored anesthesia and the spinal plus general anesthesia. The overall incidences of hypothermia, chills, and nausea and vomiting during the operation were 94(69.6%), 44(32.5%), and 15(11.1%). The incidence of chill reaction in the spinal anesthesia plus general anesthesia group was significantly lower than that in the spinal anesthesia group. The incidence of shivering in the spinal + general anesthesia group was significantly lower than the spinal group.Conclusion:Spinal anesthesia is the most commonly used anesthesia method for this type of surgery; as the operation time increases, spinal anesthesia plus monitored anesthesia or spinal anesthesia plus general anesthesia are usually required to complete the operation. Hypotension caused by acute blood loss is a common complication of the operation; a good sense of thermal insulation and active management of adverse reactions such as chills, nausea and vomiting are required during the operation.

参考文献:

[1] KWIATKOWSKI S,KWIATKOWSKA E,RZEPKA R,et al.Isehemic placental syndrome prediction and new disease monitoring[J].J Matern Fetal Neonatal Med,2015,10(7):1-7.
[2] HELLERSTEIN S,FELDMAN S,DUAN T.China's 50% caesarean delivery rate:is it too high?[J].BJOG,2015,122(2):160-164.
[3] ZENG G,YANG M,DING Y,et al.Preoperative infrarenal abdominal aorta balloon catheter occlusion combined with Bakri tamponade reduced maternal morbidity of placenta increta/percreta[J].Medicine,2017,96(38):e8114.
[4] 魏立春,龚国芸,陈江鸿,等.超声引导下腹主动脉下段球囊阻断术在凶险性前置胎盘剖宫产术中的应用[J].中华医学杂志,2018,98(12):930-934.
[5] 余琳,胡可佳,杨慧霞.2008-2014年凶险性前置胎盘的回顾性临床研究[J].中华妇产科杂志,2016,51(3):169-173.
[6] OZCAN S,KARAYALQM R,KANAT P M,et al.Multiple repeat cesarean delivery is associated with increased maternal morbidity irrespective of placenta accreata[J].Eur Rev Med Pharmacol Sci,2015,19(11):1959-1963.
[7] HIGGINS M F,MONTEITH C,FOLEY M,et al.Real increasing incidence of hysterectomy for placenta accreta following previous caesarean section[J].Eur J Obstet Gynecol Reprod Biol,2013,171(1):54-56.
[8] KAN A.Perspectives on Therapeutic Hypothermia[J].Adv Ther,2019,36(9):2223-2232.
[9] MORAMARCO V,KORALE L S,NINAN K,et al.Classical cesarean:what are the maternal and infant risks compared with low transverse cesarean in preterm birth,and subsequent uterine rupture?A systematic review and meta-analysis[J].J Obst Gynaecol Can,2020,42(2):179-197.
[10] YAMADA T,MORIH,UEKI M.Autologous blood transfusion in patients with placenta previa[J].Acta Obstet Gynecol Scand,2005,84(3):255-259.
[11] LIANG T B,LI J J,LI D L,et al.Intraoperative blood salvage and leukocyte depletion during liver transplantation with bacterial contamination[J].Clin Transplant,2010,24(2):265-272.
[12] GHI T,CONTRO E,MARTINA T,et al.Cervical length and risk of antepartum bleeding in women with complete placenta previa[J].Ultrasound in Obstet Gynecol,2009,33(2):209-212.
[13] DU X,XIE X,WANG Y.Uterine artery suture:a preventive approach for pernicious placenta previa[J].Cell Biochem Biophys,2014,68(2):407-410.
[14] SMOUT E M,SHENMAN A H.Uterine rupture following abdominal cerclage with prior classical Caesarean section[J].Obstet Gynaecol,2011,31:83-84.
[15] SNEGOVSKIKH D,1CLEBONE A,NORWITZ E.Anesthetic management of patients with placenta accreta and resuscitation strategies for associated massive hemorrhage[J].Curr Opin Anaesthesiol,2011,24(3):274-281.
[16] SOUZA J P,GüLMEZOGLU A M,VOGEL J,et al.Moving beyond essential interventions for reduction of maternal mortality (the WHO multicountry survey on maternal and newborn health):a cross-sectional study[J].The Lancet,2013,381(9879):1747-1755.
[17] MILLIGAN K R.Recent advances in local anaesthetics for spinal anaesthesia[J].Eur J Anaesthesie1,2004,21(11):837-847.
[18] MERCIER F J,AUGE M,HOFFMANN C,et al.Maternal hypotension during spinal anesthesia for caesarean delivery[J].Minerva Anestesiol,2013,79(1):62-73.
[19] NGAN K.Prevention of maternal hypotension after regional anaesthesia for caesarean section[J].Curr Opin Anaesthesiol,2010,23(3):304-309.
[20] URITS I,JONES M R,ORHURHU V,et al.A comprehensive update of current anesthesia perspectives on therapeutic hypothermia[J].Adv The,2019,36(9):2223-2232.

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