Beckmann Michael, Calderbank Susan
Department of Obstetrics and Gynaecology, Mater Health Services, South Brisbane, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2012 Aug;52(4):316-20. doi: 10.1111/j.1479-828X.2012.01457.x. Epub 2012 Jun 8.
Birth by emergency caesarean section (CS) is common and often considered urgent (category 1). In the UK, over half of all category 1 CS are performed under general anaesthesia (GA). In this setting, little is known about the effect of the mode of anaesthesia on the neonate.
A retrospective cohort study was performed using routinely collected de-identified data from Mater Health Services, Brisbane, Australia. The data set included 533 term babies born by category 1 CS for presumed fetal compromise between 2008 and 2011. Bivariate and multivariate analyses were undertaken.
The outcomes of 81 babies born by GA CS were compared with 452 by CS under regional anaesthesia (RA). Compared with a category 1 CS under RA, the decision-to-delivery interval for a GA CS was almost eight minutes faster (24.7 vs 32.6 minutes; P < 0.001). When adjusted for confounders, babies born by category 1 GA CS were significantly more likely to have an Apgar score < 7 at five minutes (aOR 6.89; 95%CI 1.79-26.55; P = 0.005), to require Neopuff or bag/mask ventilation for > 60 seconds (aOR 2.34; 95%CI 1.13-4.84; P = 0.022) and to be admitted to a neonatal intensive care nursery (aOR 2.24; 95%CI 1.16-4.31; P = 0.016).
General anaesthesia was associated with short-term neonatal morbidity of term babies born by category 1 CS for presumed fetal compromise, despite enabling a more rapid delivery of the baby. These data should help inform the discussion between anaesthetist and obstetrician, in balancing the risks and benefits of the mode of anaesthesia.
急诊剖宫产分娩很常见，且通常被视为紧急情况（1类）。在英国，超过一半的1类剖宫产是在全身麻醉（GA）下进行的。在这种情况下，关于麻醉方式对新生儿的影响知之甚少。
采用从澳大利亚布里斯班马特健康服务中心常规收集的匿名数据进行回顾性队列研究。数据集包括2008年至2011年间因假定胎儿窘迫通过1类剖宫产出生的533名足月儿。进行了双变量和多变量分析。
将81名通过全身麻醉剖宫产出生的婴儿的结局与452名通过区域麻醉（RA）剖宫产出生的婴儿的结局进行了比较。与区域麻醉下的1类剖宫产相比，全身麻醉剖宫产的决定至分娩间隔快了近8分钟（24.7对32.6分钟；P<0.001）。在对混杂因素进行调整后，通过1类全身麻醉剖宫产出生的婴儿在5分钟时Apgar评分<7的可能性显著更高（调整后比值比6.89；95%置信区间1.79 - 26.55；P = 0.005），需要使用新生儿复苏气囊或面罩通气超过60秒的可能性更高（调整后比值比2.34；95%置信区间1.13 - 4.84；P = 0.022），以及被收治入新生儿重症监护病房的可能性更高（调整后比值比2.24；95%置信区间1.16 - 4.31；P = 0.016）。
尽管全身麻醉能够更快地娩出婴儿，但对于因假定胎儿窘迫通过1类剖宫产出生的足月儿，全身麻醉与短期新生儿发病率相关。这些数据应有助于麻醉医生和产科医生在权衡麻醉方式的风险和益处时进行讨论。
