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择期剖宫产术采用全身麻醉与脊髓麻醉的比较:对新生儿短期结局的影响。一项前瞻性随机研究。

General versus spinal anaesthesia for elective caesarean sections: effects on neonatal short-term outcome. A prospective randomised study.

作者信息

Mancuso Alfredo, De Vivo Antonio, Giacobbe Annamaria, Priola Valentina, Maggio Savasta Laura, Guzzo Marianna, De Vivo Dominique, Mancuso Alba

机构信息

Department of Gynaecological, Obstetrical Sciences and Reproductive Medicine, University of Messina, Messina, Italy.

出版信息

J Matern Fetal Neonatal Med. 2010 Oct;23(10):1114-8. doi: 10.3109/14767050903572158.

Abstract

OBJECTIVE

To compare neonatal short-term outcome in patients who underwent spinal, general anaesthesia and conversion from spinal to general anaesthesia.

METHODS

One hundred seventy-nine pregnant women undergoing elective caesarean section were allocated randomly to general (n=89) or spinal anaesthesia (n=90) and compared with 63 patients who required conversion to general anaesthesia. Umbilical cord artery pH, Apgar score as well as its individual parameter and need for assisted ventilation were evaluated.

RESULTS

No differences were found in pH values (p=0.35), while the need for assisted ventilation differed significantly (p=0.001). The rate of depressed newborns was 1.1% in the spinal group, 25.9% in the general group and 12.7% in the conversion group with a significant difference for all comparisons. At 5-min, all newborns were vigorous. At 1 min, a higher score for each parameter was found in spinal group with respect to general group, while 'activity', 'grimace' and 'respiration' showed a higher score in conversion group than in general group. At 5 min, a difference was found only for 'activity'.

CONCLUSIONS

All kinds of anaesthesia seem to be safe, but loco-regional blockade shows more advantages on the neonatal outcome also when a conversion is necessary.

摘要

目的

比较接受脊髓麻醉、全身麻醉以及从脊髓麻醉转为全身麻醉的患者的新生儿短期结局。

方法

179例接受择期剖宫产的孕妇被随机分为全身麻醉组(n = 89)或脊髓麻醉组(n = 90),并与63例需要转为全身麻醉的患者进行比较。评估脐动脉pH值、阿氏评分及其各个参数以及辅助通气需求。

结果

pH值无差异(p = 0.35),而辅助通气需求差异显著(p = 0.001)。脊髓麻醉组新生儿抑制率为1.1%,全身麻醉组为25.9%,转换组为12.7%,所有比较均有显著差异。5分钟时,所有新生儿均状况良好。1分钟时,脊髓麻醉组各参数得分高于全身麻醉组,而“活动”“皱眉”和“呼吸”在转换组中的得分高于全身麻醉组。5分钟时,仅“活动”存在差异。

结论

各种麻醉似乎都是安全的,但即使在需要转换麻醉方式时,局部区域阻滞对新生儿结局也显示出更多优势。

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