本文選題：妊娠期血小板減少癥 + 連續(xù)蛛網(wǎng)膜下腔麻醉��； 參考：《山東醫(yī)藥》2017年03期

【摘要】：目的觀察合并妊娠期血小板減少癥的產(chǎn)婦剖宮產(chǎn)術(shù)應用連續(xù)蛛網(wǎng)膜下腔麻醉的可行性。方法合并妊娠期血小板減少癥行剖宮產(chǎn)術(shù)分娩的產(chǎn)婦70例,采用隨機數(shù)字表法分為CSA組、GA組各35例。CSA組手術(shù)采用布比卡因連續(xù)蛛網(wǎng)膜下腔麻醉,待麻醉平面達到T6開始手術(shù);GA組手術(shù)采用丙泊酚、瑞芬太尼、羅庫溴銨誘導全身麻醉、氣管插管后機械通氣。記錄產(chǎn)婦術(shù)前血小板計數(shù)、術(shù)中出血量、從手術(shù)切皮至胎兒娩出時間(UIDI)。比較兩組產(chǎn)婦麻醉前和麻醉后5、10、20、30 min及手術(shù)結(jié)束時的平均動脈壓(MAP)和心率(HR)。比較兩組新生兒體質(zhì)量,出生后1、5、10 min Apgar評分,臍帶動脈血血氣分析結(jié)果。觀察產(chǎn)婦有無惡心嘔吐、頭痛、馬尾綜合征、術(shù)中知曉等情況。結(jié)果 CSA組UIDI短于GA組(P0.05)。CSA組麻醉后5 min的MAP低于GA組(P0.05)。兩組新生兒出生后1 min Apgar評分均大于5分,GA組6~8分者8例,CSA組為2例,兩組相比,P0.05;兩組新生兒出生后5、10 min Apgar評分均為9~10分,差異無統(tǒng)計學意義。CSA組發(fā)生惡心嘔吐4例、頭痛1例(術(shù)后第3天緩解),GA組分別為5、0例。兩組均未發(fā)生馬尾綜合征和術(shù)中知曉情況。結(jié)論連續(xù)蛛網(wǎng)膜下腔麻醉用于妊娠期血小板減少癥產(chǎn)婦行剖宮產(chǎn)術(shù)安全可行,對胎兒影響小,不良反應較少。
[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.
【作者單位】： 首都醫(yī)科大學附屬北京婦產(chǎn)醫(yī)院;
【分類號】：R614.4

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