计划性剖宫产术肥胖产妇的麻醉并发症。

Anesthesia complications during scheduled cesarean delivery for morbidly obese women.

机构信息

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

出版信息

Am J Obstet Gynecol. 2010 Sep;203(3):276.e1-5. doi: 10.1016/j.ajog.2010.06.022. Epub 2010 Jul 31.

DOI:10.1016/j.ajog.2010.06.022

PMID:20673866

Abstract

OBJECTIVE

We sought to estimate the morbidity associated with regional anesthesia in morbidly obese women undergoing scheduled cesarean delivery.

STUDY DESIGN

This was a retrospective cohort study of women undergoing elective scheduled cesarean delivery from September 2004 through December 2008.

RESULTS

A total of 142 morbidly obese, 251 overweight and obese, and 185 normal-weight women met inclusion criteria. Differences between groups were identified regarding: complicated placement (5.6%, 2.8%, and 0%, respectively; P = .007), failure to establish (2%, 0%, and 0%, respectively; P = .047), and insufficient duration (4%, 0%, and 0%, respectively; P = .02) of regional anesthesia. The groups differed in the frequency of general anesthesia (6%, 0%, and 0%, respectively; P = .003), intraoperative hypotension (3%, 0%, and 0%, respectively; P = .01), and overall anesthetic complications (8.4%, 0%, and 0%, respectively; P < .0001). Prepregnancy body mass index > or = 40 kg/m(2) (receiver operating characteristic area under the curve, 0.856; positive likelihood ratio, 4.0) and delivery body mass index > or = 45 kg/m(2) (receiver operating characteristic area under the curve, 0.877; positive likelihood ratio, 4.1) were predictive of anesthetic complications.

CONCLUSION

Morbidly obese women have significant risk for anesthesia complications during cesarean delivery.

摘要

目的

我们旨在评估择期行剖宫产术的病态肥胖女性接受区域麻醉相关的发病率。

研究设计

这是一项回顾性队列研究，纳入了 2004 年 9 月至 2008 年 12 月期间行择期剖宫产术的女性。

结果

共有 142 例病态肥胖、251 例超重和肥胖以及 185 例正常体重的女性符合纳入标准。各组之间存在差异，具体表现为：局麻操作困难（分别为 5.6%、2.8%和 0%，P =.007）、无法置管（分别为 2%、0%和 0%，P =.047）和局麻作用时间不足（分别为 4%、0%和 0%，P =.02）。三组之间在全身麻醉的应用频率（分别为 6%、0%和 0%，P =.003）、术中低血压（分别为 3%、0%和 0%，P =.01）和总体麻醉并发症（分别为 8.4%、0%和 0%，P <.0001）的发生频率方面也存在差异。孕前 BMI≥40kg/m2（ROC 曲线下面积 0.856，阳性似然比 4.0）和分娩 BMI≥45kg/m2（ROC 曲线下面积 0.877，阳性似然比 4.1）是麻醉并发症的预测因素。