Petropoulos G, Siristatidis C, Salamalekis E, Creatsas G
Department of Anesthesiology, Aretaieion Hospital, University of Athens Medical School, Greece.
J Matern Fetal Neonatal Med. 2003 Apr;13(4):260-6. doi: 10.1080/jmf.13.4.260.266.
To compare general, epidural and combined spinal-epidural anesthesia with respect to short-term outcome of newborns delivered by elective Cesarean section of healthy parturients with normal pregnancies.
A total of 238 eight pregnant women admitted to our institution between January 1998 and July 2002, for whom elective Cesarean section was planned after 38 weeks' gestation, were grouped according to the kind of anesthesia used for the procedure. Maternal characteristics, birth weight, Apgar scores, and maternal and umbilical artery (UA) acid-base parameters were analyzed.
Maternal pH was significantly lower and pCO2: and pO2 were significantly higher in the general anesthetic group, compared to the other two groups (7.38 +/- 0.03 vs. 7.43 +/- 0.02 and 7.43 +/- 0.05, respectively; 35.03 +/- 3.88 mmHg vs. 29.25 +/- 5.05 mmHg and 29.64 +/- 4.16 mmHg, respectively; and 224.56 +/- 86.77 mmHg vs. 151.28 +/- 38 mmHg and 157.36 +/- 53.51 mmHg, respectively, p < 0.05). The pH of the UA was higher in the general anesthetic group, compared to the spinal-epidural group (7.29 +/- 0.02 vs. 7.26 +/- 0.06, p < 0.05). The pO2 as well as O2 saturation of the UA were higher when general anesthetic was administered, compared to the two regional modalities (15.60 +/- 5.48 mmHg vs. 9.29 +/- 4.41 mmHg and 9.20 +/- 4.06 mmHg, respectively; and 17.37 +/- 9.79% vs. 7.87 +/- 4.98% and 6.90 +/- 5.22%, respectively, p < 0.05). UA O2 saturation fell to zero in some cases in the combined spinal-epidural group, without an evident effect on fetal well-being. No fetal acidemia was noted in any group. Neonatal outcomes were similar in the three groups studied.
Type of anesthesia does not influence short-term outcomes in infants born via elective Cesarean section, although differences in acid-base status of both the mother and especially the newborn recommend careful use of spinal anesthesia.
比较全身麻醉、硬膜外麻醉和腰麻-硬膜外联合麻醉用于正常妊娠的健康产妇择期剖宫产时对新生儿短期结局的影响。
1998年1月至2002年7月期间，共有238名妊娠晚期（孕38周后计划行择期剖宫产）的孕妇入住我院，根据手术所采用的麻醉方式进行分组。分析产妇特征、出生体重、阿氏评分以及产妇和脐动脉（UA）的酸碱参数。
与其他两组相比，全身麻醉组产妇的pH值显著降低，pCO2和pO2显著升高（分别为7.38±0.03 vs. 7.43±0.02和7.43±0.05；35.03±3.88 mmHg vs. 29.25±5.05 mmHg和29.64±4.16 mmHg；224.56±86.77 mmHg vs. 151.28±38 mmHg和157.36±53.51 mmHg，p<0.05）。全身麻醉组脐动脉的pH值高于腰麻-硬膜外联合麻醉组（7.29±0.02 vs. 7.26±0.06，p<0.05）。与两种区域麻醉方式相比，全身麻醉时脐动脉的pO2和O2饱和度更高（分别为15.60±5.48 mmHg vs. 9.29±4.41 mmHg和9.20±4.06 mmHg；17.37±9.79% vs. 7.87±4.98%和6.90±5.22%，p<0.05）。腰麻-硬膜外联合麻醉组部分病例脐动脉O2饱和度降至零，但对胎儿健康无明显影响。所有组均未发现胎儿酸血症。研究的三组新生儿结局相似。
麻醉方式不影响择期剖宫产出生婴儿的短期结局，尽管母亲尤其是新生儿的酸碱状态存在差异，但使用腰麻时仍需谨慎。
