Brenck F, Hartmann B, Jost A, Röhrig R, Obaid R, Brüggmann D, Harbach H, Junger A
Department of Anaesthesiology, Intensive Care Medicine, University Hospital Giessen and Marburg, Campus Giessen, Germany.
Int J Obstet Anesth. 2007 Jul;16(3):208-13. doi: 10.1016/j.ijoa.2007.01.005. Epub 2007 Apr 24.
Due to the increasing number of caesarean sections, we investigated the influence of maternal bradycardia during general and regional anaesthesia on seven standard paediatric outcome parameters using our online recorded data.
Data from 1154 women undergoing caesarean section were investigated prospectively. Bradycardia was defined as a heart rate below 60 beats/min. The matched-pairs method was used to evaluate the impact of bradycardia on Apgar scores at 1, 5, and 10 min, umbilical artery pH and base excess, admission to paediatric intensive care unit, and seven-day mortality. Matched references were automatically selected among all patients from the data pool according to anaesthetic technique, sensory block height, urgency, maternal age and body mass index. Stepwise regression models were developed to predict the impact of intra-operative bradycardia on outcome variables with differences between matched pairs assessed using univariate analysis.
Bradycardia was found in 146 women (12.7%) for whom a control could be matched in 131 cases (89.7%). Mean 5-minute Apgar score was 9.2+/-1.1 for study patients and 9.3+/-1.1 for controls. pH and base excess were not significantly different between groups. In cases of urgent surgery, neonates had an increased risk of 1.8 (95% CI 1.36-2.44, P<0.01) for an Apgar score <or= 8 at 1 min and a 2.6-fold risk (95% CI 1.64-4.06, P<0.01) of umbilical arterial pH of <or= 7.2 compared to infants undergoing non-urgent procedures.
Using matched-pairs analysis we were unable to demonstrate that episodes of maternal bradycardia below 60 beats/min were associated with a poorer neonatal outcome regardless of anaesthetic technique.
由于剖宫产数量不断增加，我们利用在线记录数据，研究了全身麻醉和区域麻醉期间产妇心动过缓对七个标准儿科结局参数的影响。
对1154例行剖宫产的妇女的数据进行前瞻性研究。心动过缓定义为心率低于60次/分钟。采用配对法评估心动过缓对1、5和10分钟时的阿氏评分、脐动脉pH值和碱剩余、入住儿科重症监护病房以及七天死亡率的影响。根据麻醉技术、感觉阻滞平面、紧急程度、产妇年龄和体重指数，从数据池中所有患者中自动选择配对对照。建立逐步回归模型，以预测术中心动过缓对结局变量的影响，并使用单变量分析评估配对之间的差异。
146名妇女（12.7%）出现心动过缓，其中131例（89.7%）可找到配对对照。研究组患者的平均5分钟阿氏评分为9.2±1.1，对照组为9.3±1.1。两组间pH值和碱剩余无显著差异。在急诊手术中，与非急诊手术的婴儿相比，新生儿1分钟时阿氏评分≤8分的风险增加1.8倍（95%可信区间1.36-2.44，P<0.01），脐动脉pH值≤7.2的风险增加2.6倍（95%可信区间1.64-4.06，P<0.01）。
采用配对分析，我们未能证明每分钟低于60次的产妇心动过缓发作与较差的新生儿结局相关，无论麻醉技术如何。
