摘要
目的探讨在完备的即刻剖宫产应急处理流程下,不同麻醉方法对即刻剖宫产术的麻醉时间、分娩时间和新生儿预后的影响。方法选取2015年5月至2019年7月北京和睦家医院应用“紫色代码”启动即刻剖宫产术的患者33例,根据麻醉方式的不同分为全身麻醉组(general anesthesia,GA)10例和硬膜外麻醉组(top-up epidural anesthesia,tE DA)23例。比较不同麻醉方法,从决定剖宫产到产妇转运至手术室的时间(decision to operating room interval,DOI)、从决定剖宫产到手术开始的时间(decision to incision interval,DⅡ)、麻醉起效时间(anesthesia onset time,AOT)、决定手术至胎儿娩出的时间(decision-to-delivery interval,DDI)、从胎心减慢到胎儿娩出的时间(bradycardia to delivery interval,BDI),新生儿出生后1、5、10 min的Apgar评分和新生儿脐带血pH值的差异。结果33例患者的DOI、DⅡ、AOT、DDI和BDI分别为(4.39±2.60)min、(12.94±5.05)min、(8.22±3.77)min、(18.61±6.23)min和(24.74±7.77)min,所有患者DDI均<30 min。GA组产妇孕周数和BMI明显小于tEDA组(P<0.05)。GA组和tEDA组的DDI分别为(17.20±6.12)min和(19.22±6.31)min,两组DOI、DⅡ、AOT、DDI、BDI的组间比较差异均无统计学意义(P>0.05)。需要辅助呼吸的新生儿数组间比较差异无统计学意义。出生后1、5、10 min的新生儿Apgar评分组间比较差异无统计学意义。GA组和tEDA组分别有8例、15例新生儿出生后测定了脐带血血气,GA组pH值低于tEDA组,差异有统计学意义[(7.17±0.10)比(7.26±0.07),P<0.05]。结论具有完备应急预案的颜色代码制度可以提高产科即刻剖宫产的应急处理速度;即刻剖宫产术的麻醉选择需进行个体化分析,分娩镇痛的硬膜外导管可为即刻剖宫产手术提供较为快速的麻醉;全身麻醉与新生儿预后的关系有待进一步研究。
Objective To investigate the effects of different anesthetic techinique on anesthesia time,delivery time and neonatal prognosis of category I cesarean section under comprehensive emergency response workflow.Methods The data of patients who underwent category I cesarean sections in Code Purple from May 2015 to July 2019 in Beijing United Family Hospital.The patients were divided into general anesthesia group(GA)and top-up epidural anesthesia group(tEDA).Decision to operating room interval(DOI),decision to incision interval(DII),anesthesia onset time(AOT),decision-to-delivery interval(DDI),bradycardia to delivery interval(BDI),Apgar score at 1,5,10 min and umbilical cord blood pH were compiled and analyzed.Results Thirty-three patients who underwent category I cesarean section were included.DOI,DII,AOT,DDI and BDI were(4.39±2.60)min,(12.94±5.05)min,(8.22±3.77)min,(18.61±6.23)min and(24.74±7.77)min respectively.DDIs of all patients were shorter than 30 min.Ten patients were in group GA and 23 patients were in group tEDA.There were significant differences in gestational week and BMI between the two groups(P<0.05).DDI was(17.20±6.12)min for GA group and(19.22±6.31)min for tEDA group(P>0.05),there were also no significant differences in DOI,DII,AOT,and BDI between the two groups.There was no difference in neonate count of needing bag and mask resuscitation.Apgar scores at 1,5,10 min were comparable.Umbilical cord blood pH of group GA was lower than that of group tEDA[(7.17±0.10)vs.(7.26±0.07),P<0.05].Conclusions Code color protocol is an effective way to speed up the response to category I cesarean section.The selection of anesthetic technique should base on the personalized evaluation.Administering an epidural bolus into an already established epidural catheter that is working effectively and rapidly.The correlation between general anesthesia and neonatal outcome needs further research.
作者
杨璐
刘薇
徐国勋
徐德军
Yang Lu;Liu Wei;Xu Guoxun;Xu Dejun(Department of Anesthesiology,Beijing United Family Hospital,Beijing 100015,China)
出处
《北京医学》
CAS
2020年第3期218-221,共4页
Beijing Medical Journal
