Dasgupta Subhankar, Chakraborty Barunoday, Saha Debdas, Ghosh Debdutta
Department of Obstetrics and Gynaecology, Bankura Sammilani Medical College, Bankura 722102.
J Indian Med Assoc. 2011 Mar;109(3):166-70.
Ideal method of anaesthesia during caesarean section in women with severe pre-eclampsia is difficult to decide. The aim and objective of the study were to compare neonatal outcome in women with severe pre-eclampsia, undergoing caesarean section in intrapartum period, either under general or spinal anaesthesia. Women with severe pre-eclampsia, undergoing caesarean section in intrapartum period, were included in the study. Diastolic blood pressure was kept below 100mm Hg by giving parenteral labetalol pre-operatively. All women received prophylactic magnesium sulphate (5g IV and 10g IM). Maternal blood- gas parameters were measured. Scalp blood pH estimation was done in all cases. Women undergoing caesarean section were randomised into two groups and received either spinal or general anaesthesia. Umbilical arterial catheterisation was done for collecting blood for estimating neonatal blood- gas parameters. Complete data was available in 82 women. Both the groups were comparable in terms of general demographic data, except that percentage of women having an induced labour was significantly more in the general anaesthesia group. Induction of anaesthesia and delivery interval was prolonged for the spinal group. Mean dose of phenylephrine was significantly higher for the spinal anaesthesia group. Preoperative maternal blood-gas parameters and foetal scalp blood pH were comparable in between groups. Difference in neonatal umbilical artery base deficit in between groups was not statistically significant (p = 0.99). Correlation coefficient between maternal base deficit and foetal base deficit was 0.414 (p = 0.01) and 0.06 (p > 0.1) respectively for general and spinal anaesthesia. Subgroup analysis in the population with pre-operative scalp blood pH < 7.2, neonatal umbilical artery base deficit was significantly higher in general anaesthesia group. Five minutes APGAR score was comparable but resuscitation at birth was more common in the general anaesthesia group. Correlation coefficient between maternal base deficit and foetal base deficit in this subgroup was 0.42 (p = 0.05) and -0.57 (p < 0.05) respectively for general and spinal anaesthesia.
对于重度子痫前期女性剖宫产期间的理想麻醉方法很难抉择。本研究的目的是比较重度子痫前期女性在产时接受剖宫产时，采用全身麻醉或脊髓麻醉后的新生儿结局。纳入研究的对象为在产时接受剖宫产的重度子痫前期女性。术前通过静脉注射拉贝洛尔使舒张压维持在100mmHg以下。所有女性均接受硫酸镁预防性治疗（静脉注射5g，肌肉注射10g）。测量产妇的血气参数。所有病例均进行头皮血pH值测定。接受剖宫产的女性被随机分为两组，分别接受脊髓麻醉或全身麻醉。进行脐动脉插管以采集血液用于评估新生儿血气参数。82名女性有完整数据。两组在一般人口统计学数据方面具有可比性，但全身麻醉组引产女性的比例显著更高。脊髓麻醉组的麻醉诱导至分娩间隔时间延长。脊髓麻醉组去氧肾上腺素的平均剂量显著更高。两组间术前产妇血气参数和胎儿头皮血pH值具有可比性。两组间新生儿脐动脉碱缺失差异无统计学意义（p = 0.99）。全身麻醉和脊髓麻醉时，产妇碱缺失与胎儿碱缺失的相关系数分别为0.414（p = 0.01）和0.06（p > 0.1）。在术前头皮血pH < 7.2的人群中进行亚组分析，全身麻醉组新生儿脐动脉碱缺失显著更高。5分钟阿氏评分具有可比性，但全身麻醉组出生时复苏更为常见。在该亚组中，全身麻醉和脊髓麻醉时产妇碱缺失与胎儿碱缺失的相关系数分别为0.42（p = 0.05）和 -0.57（p < 0.05）。
