本文選題：剖宮產(chǎn)　切入點：吸入性肺炎　出處：《浙江大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 估計采用腰硬聯(lián)合麻醉剖宮產(chǎn)產(chǎn)婦術(shù)后吸入性肺炎的發(fā)病率,同時分析剖宮產(chǎn)產(chǎn)婦術(shù)后發(fā)生吸入性肺炎的預(yù)后情況及預(yù)防措施。 方法： 連續(xù)選取腰硬聯(lián)合麻醉剖宮產(chǎn)產(chǎn)婦117名。排除標(biāo)準(zhǔn)：術(shù)前存在咳嗽、血象增高和(或)發(fā)熱患者。術(shù)后第1天行胸部x線及血常規(guī)檢查,觀察記錄咳嗽、氣急、胸悶等臨床癥狀。吸入性肺炎的診斷是基于術(shù)后第一天胸部x線影像表現(xiàn),輔以咳嗽、氣急、胸悶等臨床癥狀及肺部聽診,血常規(guī)檢查。至少通過一名有經(jīng)驗的臨床醫(yī)師及一名有經(jīng)驗的放射科醫(yī)師進(jìn)行診斷。腰硬聯(lián)合麻醉均采用羅哌卡因(規(guī)格：0.75%10ml/支)10-15mg腰麻基礎(chǔ)上,硬膜外置管加用羅哌卡因(45mg以內(nèi))或左布比卡因(100mg以內(nèi))。除擇期手術(shù)產(chǎn)婦術(shù)前予以8小時內(nèi)禁食預(yù)防肺吸入外,沒有采取其他預(yù)防措施如制酸劑使用等。 結(jié)果： 117例患者中11例診斷為吸入性肺炎,7例診斷為疑似吸入性肺炎。吸入性肺炎的發(fā)生率為9.4-15.4%。11例確診病例中有臨床陽性癥狀者僅4例：1例表現(xiàn)為氣急、發(fā)熱(39℃),肺部聽診右下肺少許濕羅音,1例輕度胸悶不適,1例咳嗽,另有1例僅表現(xiàn)為中度發(fā)熱(38～38.5℃)；7例可疑病例有陽性癥狀者僅2例,1例表現(xiàn)為咳嗽,1例僅為中度發(fā)熱(38～38.5℃)。99例肺部X線檢查正常者中僅1例為輕度咳嗽。11例確診吸入性肺炎的患者術(shù)后第一天血象異常者(白細(xì)胞10×109/L及中性粒比值0.7)6例,7例疑似吸入性肺炎患者中血象異常者3例；99例肺部X線檢查正常者術(shù)后第1天血象異常者41例。與99例肺部X線檢查正常者進(jìn)行統(tǒng)計學(xué)比較,確診及疑似吸入性肺炎患者術(shù)后第1天血象異常的發(fā)生率、白細(xì)胞及中性粒細(xì)胞比值均無統(tǒng)計學(xué)意義。11例確診患者中的4例及7例疑似患者中的2例進(jìn)行了細(xì)菌培養(yǎng),其中確診患者中的1例陽性,為非耐藥肺炎克雷伯菌亞種。肺部X線檢查正常者術(shù)后住院時間為(4.9±0.4)d,確診及疑似吸入性肺炎患者術(shù)后住院時間為(6.5±1.8)d,兩者進(jìn)行統(tǒng)計學(xué)比較有顯著差異(P0.01)。吸入性肺炎患者中一例患者住院1周后呼吸道癥狀未控制的情況下簽字出院,出院后3天因呼吸道癥狀及發(fā)熱表現(xiàn)再次入院,治療1周后好轉(zhuǎn)出院。沒有產(chǎn)婦死亡。 結(jié)論： 在通過胸部X線診斷吸入性肺炎的基礎(chǔ)上我們研究腰硬聯(lián)合麻醉下剖宮產(chǎn)產(chǎn)婦吸入性肺炎的發(fā)生率為9.4-15.4%,遠(yuǎn)高于我們過去的一些認(rèn)識。剖宮產(chǎn)產(chǎn)婦術(shù)后發(fā)生吸入性肺炎的患者術(shù)后住院時間較未發(fā)生吸入性肺炎者明顯延長。我們有必要選擇除外增加使用區(qū)域麻醉的其他預(yù)防措施降低發(fā)病率。
[Abstract]:Objective:. To estimate the incidence of aspiration pneumonia after cesarean section under combined spinal-epidural anesthesia, and to analyze the prognosis and preventive measures of aspiration pneumonia after cesarean section. Methods:. 117 cases of cesarean section under combined spinal-epidural anesthesia were selected continuously. Exclusion criteria: patients with cough, hyperhaematology and / or fever before operation. Chest X-ray and routine blood examination were performed on the first day after operation. Cough was observed and recorded. Chest tightness and other clinical symptoms. The diagnosis of aspiration pneumonia is based on chest X-ray findings on the first day after operation, supplemented by clinical symptoms such as cough, shortness of breath, chest tightness, and lung auscultation. Blood routine examination. Diagnosed by at least one experienced clinician and one experienced radiologist. Combined spinal-epidural anesthesia was performed on the basis of ropivacaine (10-15 mg ml/). Epidural catheterization plus ropivacaine (45mg) or levobupivacaine (100mg). No other preventive measures, such as acid preparation, were taken except for prevention of lung inhalation by fasting within 8 hours before elective operation. Results:. Of the 117 patients, 11 cases were diagnosed as inhaled pneumonia and 7 cases were diagnosed as suspected aspiration pneumonia. The incidence of inhaled pneumonia was 9.4-15.4.11 cases of confirmed cases had clinical positive symptoms. Fever was 39 鈩，

本文編號：1601949