麻醉预测因素对剖宫产术后住院时间及不良事件的影响：对840例连续产妇的回顾性研究
Impact of Anesthetic Predictors on Postpartum Hospital Length of Stay and Adverse Events Following Cesarean Delivery: A Retrospective Study in 840 Consecutive Parturients.
作者信息
Oh Ting Ting, Martel Colleen G, Clark Allison G, Russo Melissa B, Nossaman Bobby D
机构信息
Department of Anesthesia, KK Women's and Children's Hospital, Singapore.
Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
出版信息
Ochsner J. 2015 Fall;15(3):228-36.
BACKGROUND
Cesarean deliveries are increasing, and associated postoperative adverse events are extending hospitalizations. The aims of the present study were to analyze the role of anesthestic predictors during cesarean delivery on the incidences of extended postpartum hospital length of stay (>4 postoperative days) and adverse events.
METHODS
The medical records of 840 consecutive patients who underwent cesarean delivery during a 1-year period were abstracted. Previously reported anesthetic predictors underwent recursive partitioning with 5-fold cross-validation and with LogWorth values ≥2.0 statistically significant at the <0.01 level.
RESULTS
In this study of 840 cesarean delivery patients, 120 parturients (14.3%; confidence interval 12.1%-16.8%) experienced extended postpartum hospital length of stay (>4 hospital days). One anesthetic predictor associated with extended postpartum hospital length of stay was type of anesthetic technique: a 25.6% incidence in parturients receiving general or epidural anesthesia compared to a 9.6% incidence in parturients receiving either spinal or combined spinal-epidural anesthesia (LogWorth value of 7.3). When the amount of intravenous fluids intraoperatively administered to Americian Society of Anesthesiologists Physical Status III and IV parturients was ≥2,000 mL, the incidence of extended postpartum hospital length of stay decreased from a baseline value of 30.0% to 17.3% (LogWorth value of 2.8). The incidence of adverse events ranged from 0%-5.0%. All regional anesthetic techniques were significantly associated with a decreased incidence of adverse events: 0.7% with spinal anesthesia, 1.9% with epidural anesthesia, and 3.2% with combined spinal-epidural anesthesia when compared to the 51.4% incidence associated with general anesthesia (LogWorth value of 4.0).
CONCLUSION
These findings suggest that type of anesthetic technique and amount of intraoperative fluids administered during cesarean delivery have important effects on the incidences of extended postpartum hospital length of stay and adverse events following cesarean delivery.
背景
剖宫产率在不断上升，与之相关的术后不良事件延长了住院时间。本研究的目的是分析剖宫产术中麻醉预测因素对产后住院时间延长（术后超过4天）及不良事件发生率的影响。
方法
提取了840例在1年期间连续接受剖宫产手术患者的病历。对先前报道的麻醉预测因素进行递归划分，并采用5折交叉验证，LogWorth值≥2.0在<0.01水平具有统计学意义。
结果
在这项对840例剖宫产患者的研究中，120例产妇（14.3%；置信区间12.1%-16.8%）经历了产后住院时间延长（住院超过4天）。与产后住院时间延长相关的一个麻醉预测因素是麻醉技术类型：接受全身或硬膜外麻醉的产妇发生率为25.6%，而接受脊麻或腰麻-硬膜外联合麻醉的产妇发生率为9.6%（LogWorth值为7.3）。当术中给予美国麻醉医师协会身体状况III级和IV级产妇的静脉输液量≥2000 mL时，产后住院时间延长的发生率从基线值30.0%降至17.3%（LogWorth值为2.8）。不良事件发生率在0%-5.0%之间。所有区域麻醉技术均与不良事件发生率降低显著相关：脊麻为0.7%，硬膜外麻醉为1.9%，腰麻-硬膜外联合麻醉为3.2%，而全身麻醉的发生率为51.4%（LogWorth值为4.0）。
结论
这些发现表明，剖宫产术中的麻醉技术类型和术中输液量对剖宫产术后产后住院时间延长及不良事件的发生率有重要影响。
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