剖宫产术的全身麻醉与脊髓麻醉：一项半对照试验。

Tafish Raed, El Aish Khaled I Abu, Madi Walid

Anaesthesia Department, Rafah, Gaza Strip, occupied Palestinian territory.

Pharmacy Department, Rafah, Gaza Strip, occupied Palestinian territory.

Lancet. 2018 Feb 21;391 Suppl 2:S33. doi: 10.1016/S0140-6736(18)30399-4.

BACKGROUND

General anaesthesia and spinal anaesthesia are commonly used for caesarean sections. The aim of this study was to compare the outcomes from caesarean sections with these two types of anaesthesia.

METHODS

In this quasi-controlled trial, we enrolled women undergoing caesarean sections at Al-Helal Al-Emirati Hospital, Rafah, Gaza Strip. Women were assigned either to general anaesthesia (20% intravenous propofol for anaesthesia induction followed by atracurium for muscle relaxation, and nitrous oxide and oxygen for anaesthesia maintenance) or to spinal anaesthesia (0·5% hyperbaric solution bupivacaine with 20 μg fentanyl intrathecally). Outcome measures were length of hospital stay, length of operation, postoperative pain assessment by visual analogue scales (VAS; range 0-10, where 0 is no pain and 10 is very bad pain) 1 hour after the operation, time from anaesthesia to demand for analgesia, amount of analgesics used in 24 h, and headache after the operation. Data were analysed using SPSS version 20. Groups were compared using the Mann-Whitney U-test, Student's t test, and odds ratio. A p value less than 0·05 was significant. The study was approved by the hospital ethics committee, and verbal informed consent was obtained from each participant.

FINDINGS

181 women (aged 19-46·5 years) were enrolled in this study. 79 women received general anaesthesia, and 102 women received spinal anaesthesia. The women did not differ in baseline characteristics such as mean age (30·6 years [SD 6·5] in the general anaesthesia group vs 28·5 years [5·4] in the spinal anaesthesia group; p=0·077), and weight (82·2 kg [SD 14·2] vs 28·5 kg [5·4]; p=0·263). We found no difference between the groups in length of hospital stay (38·7 h [SD 14·5] vs 40·1 h [12·5]; p=0·541), duration of caesarean section (39·9 min [SD 10·1] vs 41·6 min [9·1]; p=0·077), time to demand for analgesia (2·4 h [SD 2·0] vs 2·5 h [1·1]; p=0·634), and hospital readmission (odds ratio 0·77, 95% CI 0·11-5·59). VAS 1 h after the operation was higher in the general anaesthesia group than in spinal anaesthesia group (5·43 [SD 2·9] vs 2·38 [2·32]; p=0·001). Fewer patients who had general anaesthesia needed second and third analgesics than patients who had spinal anaesthesia (23% of women in the general anaesthesia group vs 47% of women in spinal anaesthesia group needed two analgesics; 4% vs 27% needed three or more analgesics; p<0·0001). Two patients in the spinal anaesthesia group had headache after the operation (OR 0·559, 95% CI 0·490-0·636).

INTERPRETATION

General and spinal anaesthesia had a similar safety profile and can be applied according to patients' needs and medical situation in the hospital.

FUNDING

None.

背景

全身麻醉和脊髓麻醉常用于剖宫产手术。本研究旨在比较这两种麻醉方式下剖宫产手术的结果。

方法

在这项准对照试验中，我们纳入了加沙地带拉法市阿联酋哈拉勒医院接受剖宫产手术的女性。将女性分为全身麻醉组（诱导麻醉采用20%静脉注射丙泊酚，随后使用阿曲库铵进行肌肉松弛，维持麻醉使用氧化亚氮和氧气）或脊髓麻醉组（鞘内注射0.5%高比重布比卡因溶液与20μg芬太尼）。观察指标包括住院时间、手术时长、术后1小时采用视觉模拟评分法（VAS；范围0 - 10，0表示无疼痛，10表示剧痛）评估的术后疼痛、从麻醉到需要镇痛的时间、24小时内使用的镇痛药物量以及术后头痛情况。使用SPSS 20版软件进行数据分析。采用曼 - 惠特尼U检验、学生t检验和比值比比较组间差异。p值小于0.05具有统计学意义。本研究经医院伦理委员会批准，并获得每位参与者的口头知情同意。

结果

181名女性（年龄19 - 46.5岁）纳入本研究。79名女性接受全身麻醉，102名女性接受脊髓麻醉。两组女性在基线特征方面无差异，如平均年龄（全身麻醉组为30.6岁[标准差6.5]，脊髓麻醉组为28.5岁[5.4]；p = 0.077）和体重（82.2 kg[标准差14.2]对28.5 kg[5.4]；p = 0.263）。我们发现两组在住院时间（38.7小时[标准差14.5]对40.1小时[12.5]；p = 0.541）、剖宫产手术时长（39.9分钟[标准差10.1]对41.6分钟[9.1]；p = 0.077）、需要镇痛的时间（2.4小时[标准差2.0]对2.5小时[1.1]；p = 0.634）以及再次入院率（比值比0.77，95%置信区间0.11 - 5.59）方面无差异。术后1小时全身麻醉组的VAS评分高于脊髓麻醉组（5.43[标准差2.9]对2.38[2.32]；p = 0.001）。全身麻醉组需要第二剂和第三剂镇痛药的患者少于脊髓麻醉组（全身麻醉组23%的女性需要两剂镇痛药，脊髓麻醉组为47%；4%对27%需要三剂或更多镇痛药；p < 0.oooooooo1）。脊髓麻醉组有两名患者术后出现头痛（比值比0.559，95%置信区间0.490 - 0.636）。