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与全身麻醉相比,择期剖宫产的脊髓麻醉与较短的住院时间相关。

Spinal anesthesia for elective cesarean section is associated with shorter hospital stay compared to general anesthesia.

作者信息

Havas Fadıl, Orhan Sungur Mukadder, Yenigün Yılmaz, Karadeniz Meltem, Kılıç Miray, Özkan Seyhan Tülay

机构信息

Department of Anesthesiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.

出版信息

Agri. 2013;25(2):55-63. doi: 10.5505/agri.2013.42204.

Abstract

OBJECTIVES

This prospective study aims to compare maternal and neonatal effects of spinal and general anesthesia for elective cesarean section.

METHODS

Term parturients receiving routine spinal (Group SA, n=95) or general (Group GA, n=93) anesthesia and standard postoperative analgesia for elective cesarean section were included in this study. Operation time, incision-hysterotomy (TS-H) and hysterotomy-umbilical cord clamping (TH-U) intervals, oxytocine requirement, intraoperative fluids, ephedrine requirement, incidence of hypotension, time to first analgesic requirement (Tanalg), pethidine consumption, adverse events, time to first breastfeeding, oral food intake (TOI), flatulence (TF), defecation (TD), mobilization, and postoperative hospital stay were compared between the groups. Newborn Apgar scores, umbilical venous blood gas analysis, incidence of hypoglycemia, nutritional support, phototherapy and ventilatory support were also analyzed.

RESULTS

Spinal anesthesia was associated with longer TS-H and TH-U durations, lower oxytocine requirements, higher incidence of hypotension, increased ephedrine and fluid consumption, and delayed Tanalg. Furthermore, TOI, TF, TD and postoperative hospital stay was shorter in patients given spinal anesthesia when compared with patients given general anesthesia (48h vs. 52 h, respectively; p<0.01). No difference in postoperative analgesic consumption and neonatal outcomes, except 1st min Apgar scores and umbilical blood gas analysis, was detected.

CONCLUSION

Spinal anesthesia, when compared to general anesthesia shortens postoperative hospital stay with early return of gastrointestinal functions in elective cesarean section.

摘要

目的

本前瞻性研究旨在比较择期剖宫产脊髓麻醉和全身麻醉对母婴的影响。

方法

本研究纳入接受常规脊髓麻醉(SA组,n = 95)或全身麻醉(GA组,n = 93)以及择期剖宫产标准术后镇痛的足月产妇。比较两组的手术时间、切开子宫肌层(TS - H)和子宫肌层切开至脐带夹闭(TH - U)间隔时间、缩宫素需求量、术中液体量、麻黄碱需求量、低血压发生率、首次镇痛需求时间(Tanalg)、哌替啶消耗量、不良事件、首次母乳喂养时间、经口进食时间(TOI)、胃肠胀气(TF)、排便(TD)、活动情况及术后住院时间。还分析了新生儿阿氏评分、脐静脉血气分析、低血糖发生率、营养支持、光疗和通气支持情况。

结果

脊髓麻醉与TS - H和TH - U持续时间延长、缩宫素需求量降低、低血压发生率升高、麻黄碱和液体消耗量增加以及Tanalg延迟有关。此外,与全身麻醉患者相比,接受脊髓麻醉的患者TOI、TF、TD及术后住院时间更短(分别为48小时和52小时;p < 0.01)。除第1分钟阿氏评分和脐血血气分析外,术后镇痛药物消耗量和新生儿结局无差异。

结论

与全身麻醉相比,脊髓麻醉可缩短择期剖宫产术后住院时间,并使胃肠功能更早恢复。

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