全麻与区域麻醉用于急性胎儿窘迫剖宫产术的比较：一项回顾性队列研究。
General versus regional anaesthesia for caesarean section indicated for acute foetal distress: a retrospective cohort study.
机构信息
Department of Anaesthesiology and Critical Care, Douala General Hospital, Douala, Cameroon.
Department of Surgery and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, 1 Yaoundé, Douala, Cameroon.
出版信息
BMC Anesthesiol. 2021 Mar 4;21(1):68. doi: 10.1186/s12871-021-01289-7.
BACKGROUND
Acute foetal distress (AFD) is a life-threatening foetal condition complicating 2% of all pregnancies and accounting for 8.9% of caesarean sections (CS) especially in developing nations. Despite the severity of the problem, no evidence exists as to the safest anaesthetic technique for the mother and foetus couple undergoing CS for AFD. We aimed to compare general anaesthesia (GA) versus regional (spinal and epidural) anaesthesia in terms of their perioperative maternal and foetal outcomes.
METHODS
We carried out a retrospective cohort study by reviewing the medical records of all women who underwent CS indicated for AFD between 2015 to 2018 at the Douala General Hospital, Cameroon. Medical records of neonates were also reviewed. We sought to investigate the association between GA, and regional anaesthesia administered during CS for AFD and foetal and maternal outcomes. The threshold of statistical significance was set at 0.05.
RESULTS
We enrolled the medical records of 117 pregnant women who underwent CS indicated for AFD. Their mean age and mean gestational age were 30.5 ± 4.8 years and 40 weeks respectively. Eighty-three (70.9%), 29 (24.8%) and 05 (4.3%) pregnant women underwent CS under SA, GA and EA respectively. Neonates delivered by CS under GA were more likely to have a significantly low APGAR score at both the 1st (RR = 1.93, p = 0.014) and third-minute (RR = 2.52, p = 0.012) and to be resuscitated at birth (RR = 2.15, p = 0.015). Past CS, FHR pattern on CTG didn't affect these results in multivariate analysis. Adverse maternal outcomes are shown to be higher following SA when compared to GA.
CONCLUSION
The study infers an association between CS performed for AFD under GA and foetal morbidity. This, however, failed to translate into a difference in perinatal mortality when comparing GA vs RA. This finding does not discount the role of GA, but we emphasize the need for specific precautions like adequate anticipation for neonatal resuscitation to reduce neonatal complications associated with CS performed for AFD under GA.
背景
急性胎儿窘迫（AFD）是一种危及生命的胎儿情况，影响所有妊娠的 2%，占剖宫产（CS）的 8.9%，尤其是在发展中国家。尽管问题严重，但对于因 AFD 而行 CS 的母亲和胎儿，没有证据表明哪种麻醉技术最安全。我们旨在比较全身麻醉（GA）与区域麻醉（脊髓和硬膜外麻醉）在围手术期母婴结局方面的差异。
方法
我们通过回顾 2015 年至 2018 年期间在喀麦隆杜阿拉总医院因 AFD 而行 CS 的所有女性的病历，进行了一项回顾性队列研究。还回顾了新生儿的病历。我们试图调查在 CS 中给予 GA 和区域麻醉与胎儿和母亲结局之间的关联。统计显著性阈值设为 0.05。
结果
我们纳入了 117 名因 AFD 而行 CS 的孕妇的病历。她们的平均年龄和平均孕龄分别为 30.5±4.8 岁和 40 周。83（70.9%）、29（24.8%）和 05（4.3%）名孕妇分别在 SA、GA 和 EA 下接受 CS。GA 下分娩的新生儿在第 1 分钟（RR=1.93，p=0.014）和第 3 分钟（RR=2.52，p=0.012）时 APGAR 评分显著较低，并且出生时需要复苏的可能性更高（RR=2.15，p=0.015）。过去的 CS 和 CTG 上的 FHR 模式在多变量分析中并没有影响这些结果。与 GA 相比，SA 时不良母婴结局更高。
结论
本研究推断 GA 下因 AFD 而行 CS 与胎儿发病率之间存在关联。然而，当比较 GA 与 RA 时，这并没有转化为围产期死亡率的差异。这一发现并没有否定 GA 的作用，但我们强调需要采取具体的预防措施，如充分预期新生儿复苏，以减少 GA 下因 AFD 而行 CS 相关的新生儿并发症。
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