Schulzeck S, Gleim M, Palm S
Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany.
Anaesthesist. 2003 Sep;52(9):787-94. doi: 10.1007/s00101-003-0553-4.
Regional anaesthesia is recommended for caesarean section in obese women. With regard to this aspect anaesthesia practice in the obstetrics department of the University Hospital Kiel was evaluated retrospectively.
Data from 1,461 consecutive caesarean sections were evaluated. Pregnant women were subgrouped according to their prepartal body mass index (BMI). Statistics were performed by the chi(2)-test and the Wilcoxon and Mann-Whitney U-test, with a significance threshold of p<0.05.
Of the pregnant women who underwent a caesarean section 27% were obese (BMI 30.0-34.9) and 15% were extremely obese (BMI > or =35). Spinal anaesthesia was performed most frequently in 47% with an uptrend in severely obese parturients. All other aspects investigated were independent of BMI. Vasoactive drugs were given less during general anaesthesia than in regional anaesthesia (3 vs. 54%). APGAR values were significantly better with regional anaesthesia, but perioperative complaints of distress were more common. Spinal anaesthesia was favoured by patients and staff in the postoperative survey ( p<0.001).
Obesity is a common risk factor in caesarean section anaesthesia. Spinal anaesthesia can be recommended even for obese parturients.
对于肥胖女性剖宫产建议采用区域麻醉。就此方面，对基尔大学医院产科的麻醉实践进行回顾性评估。
对1461例连续剖宫产的数据进行评估。孕妇根据产前体重指数（BMI）进行亚组划分。采用卡方检验、威尔科克森检验和曼 - 惠特尼U检验进行统计学分析，显著性阈值为p<0.05。
接受剖宫产的孕妇中，27%为肥胖（BMI 30.0 - 34.9），15%为极度肥胖（BMI≥35）。脊髓麻醉最常施行，占47%，且在严重肥胖产妇中有上升趋势。所调查的所有其他方面均与BMI无关。全身麻醉期间给予血管活性药物的比例低于区域麻醉（3%对54%）。区域麻醉时阿氏评分显著更好，但围手术期不适主诉更为常见。在术后调查中，脊髓麻醉受到患者和工作人员的青睐（p<0.001）。
肥胖是剖宫产麻醉中的常见危险因素。即使对于肥胖产妇也可推荐采用脊髓麻醉。
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