發(fā)布時(shí)間：2018-02-17 02:55

  本文關(guān)鍵詞： 胎盤植入 剖宮產(chǎn)術(shù) 麻醉　出處：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年02期 　論文類型：期刊論文

【摘要】：目的:研究合并胎盤植入行剖宮產(chǎn)術(shù)患者的麻醉方式選擇。方法:通過國(guó)際疾病分類(International Classification of Diseases,ICD)-9查詢2008年至2013年北京大學(xué)第三醫(yī)院出院診斷包含"胎盤植入"的病例,剔除自然產(chǎn)、剖宮取胎及非我院首診病例,共有96例納入到本次研究中。根據(jù)植入程度分為粘連型、植入型、穿透型3組,分析手術(shù)開始至胎兒娩出時(shí)間、麻醉方式選擇。結(jié)果:96例患者中粘連型49例、植入型33例、穿透型14例,粘連組、植入組、穿透組的手術(shù)開始至胎兒娩出的時(shí)間平均分別為(6.7±3.0)min、(7.2±4.6)min、(11.9±4.9)min,穿透組與粘連組、植入組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。不同植入程度麻醉方式選擇差異有統(tǒng)計(jì)學(xué)意義(P0.001),其中粘連組45例(91.8%)患者行椎管內(nèi)麻醉,2例(4.1%)行全身麻醉,2例(4.1%)先行椎管內(nèi)麻醉后術(shù)中轉(zhuǎn)為全身麻醉;植入組22例(66.7%)患者行椎管內(nèi)麻醉,4例(12.1%)行全身麻醉,7例(21.2%)先行椎管內(nèi)麻醉后術(shù)中轉(zhuǎn)為全身麻醉;穿透組有2例(14.3%)患者行椎管內(nèi)麻醉,2例(14.3%)行全身麻醉,10例(71.4%)先行椎管內(nèi)麻醉,后術(shù)中轉(zhuǎn)為全身麻醉。結(jié)論:椎管內(nèi)麻醉可作為合并胎盤植入行剖宮產(chǎn)術(shù)麻醉的首選方法,若術(shù)前提示穿透型胎盤植入,需做好全身麻醉的準(zhǔn)備。
[Abstract]:Objective: to study the anesthetic choice of patients undergoing caesarean section with placenta accreta. Methods: from 2008 to 2013, the patients who were discharged from the third Hospital of Peking University who were diagnosed as "placenta accreta" were investigated by the International Classification of Diseases (ICD- 9). A total of 96 cases were included in this study. According to the degree of implantation, 96 cases were divided into three groups: adhesive type, implantable type and penetrating type. The time from the beginning of operation to the delivery of the fetus was analyzed. Results in 96 cases, 49 cases of adherent type, 33 cases of implantable type, 14 cases of penetrating type, the average time from the beginning of operation to fetal delivery in adhesive group, implant group, penetrating group and penetrating group were 6.7 鹵3.0 min, 7.2 鹵4.6 min, 11.9 鹵4.9 min, respectively, and the mean time between penetrating group and adhesion group was 11.9 鹵4.9 min. There were significant differences between the implanted group and the other two groups (P 0.05). There were significant differences in the choice of anesthesia methods among the different implantation degrees (45 cases in the adhesion group were treated with intraspinal anesthesia (n = 2) and 4. 1%) (2 cases were treated with general anesthesia (n = 2) after intraspinal anaesthesia) after intraspinal anesthesia (n = 45, n = 45, n = 45, n = 45, n = 91.8). Conversion to general anesthesia during operation; In the implantation group, 22 patients were treated with intraspinal anesthesia (n = 22) and 4 patients received intraspinal anesthesia (n = 4) and 7 patients underwent general anesthesia (n = 7). In the penetrating group, 2 patients were treated with intraspinal anesthesia (n = 2, n = 2) and 10 patients received general anesthesia (n = 10, n = 71.4). Conclusion: spinal canal anesthesia can be used as the first choice for caesarean section anesthesia with placenta accreta. If we suggest penetrating placenta accreta before operation, we should prepare for general anesthesia.
【作者單位】： 北京大學(xué)第三醫(yī)院麻醉科;
【分類號(hào)】：R614

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