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全身麻醉与脊髓麻醉下行剖宫产术患者的母婴结局比较:一项随机临床试验。

Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial.

作者信息

Saygı Anıl İçel, Özdamar Özkan, Gün İsmet, Emirkadı Hakan, Müngen Ercüment, Akpak Yaşam Kemal

机构信息

Department of Obstetrics and Gynecology, Ankara Military Hospital, Ankara, Turkey.

Department of Obstetrics and Gynecology, Gölcük Military Hospital, Gölcük, Kocaeli, Turkey.

出版信息

Sao Paulo Med J. 2015 May-Jun;133(3):227-34. doi: 10.1590/1516-3180.2014.8901012. Epub 2015 Jun 1.

Abstract

CONTEXT AND OBJECTIVE

As the rates of cesarean births have increased, the type of cesarean anesthesia has gained importance. Here, we aimed to compare the effects of general and spinal anesthesia on maternal and fetal outcomes in term singleton cases undergoing elective cesarean section.

DESIGN AND SETTING

Prospective randomized controlled clinical trial in a tertiary-level public hospital.

METHODS

Our study was conducted on 100 patients who underwent cesarean section due to elective indications. The patients were randomly divided into general anesthesia (n = 50) and spinal anesthesia (n = 50) groups. The maternal pre and postoperative hematological results, intra and postoperative hemodynamic parameters and perinatal results were compared between the groups.

RESULTS

Mean bowel sounds (P = 0.036) and gas discharge time (P = 0.049) were significantly greater and 24th hour hemoglobin difference values (P = 0.001) were higher in the general anesthesia group. The mean hematocrit and hemoglobin values at the 24th hour (P = 0.004 and P < 0.001, respectively), urine volume at the first postoperative hour (P < 0.001) and median Apgar score at the first minute (P < 0.0005) were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer (P = 0.042), in the spinal anesthesia group.

CONCLUSION

In elective cases, spinal anesthesia is superior to general anesthesia in terms of postoperative comfort. In pregnancies with a risk of fetal distress, it would be appropriate to prefer spinal anesthesia by taking the first minute Apgar score into account.

摘要

背景与目的

随着剖宫产率的上升,剖宫产麻醉方式变得愈发重要。在此,我们旨在比较全身麻醉和脊髓麻醉对择期剖宫产足月单胎产妇及胎儿结局的影响。

设计与地点

在一家三级公立医院进行的前瞻性随机对照临床试验。

方法

我们的研究纳入了100例因择期指征行剖宫产的患者。患者被随机分为全身麻醉组(n = 50)和脊髓麻醉组(n = 50)。比较两组产妇术前和术后的血液学结果、术中及术后的血流动力学参数以及围产期结局。

结果

全身麻醉组的平均肠鸣音(P = 0.036)和排气时间(P = 0.049)显著更长,且术后24小时血红蛋白差值(P = 0.001)更高。脊髓麻醉组术后24小时的平均血细胞比容和血红蛋白值(分别为P = 0.004和P < 0.001)、术后第一小时尿量(P < 0.001)以及第一分钟的阿氏评分中位数(P < 0.0005)显著更高,且首次需要镇痛的时间显著更长(P = 0.042)。

结论

在择期剖宫产病例中,脊髓麻醉在术后舒适度方面优于全身麻醉。对于有胎儿窘迫风险的妊娠,考虑到第一分钟阿氏评分,选择脊髓麻醉是合适的。

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