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[延长硬膜外分娩镇痛增加了硬膜外镇痛转换为剖宫产失败的风险]

[Prolonged epidural labor analgesia increases risks of epidural analgesia failure for conversion to cesarean section].

作者信息

Zhu S, Wei D, Zhang D, Jia F, Liu B, Zhang J

机构信息

Department of Anesthesiology, Sichuan Provincial Maternity and Child Health Care Hospital/Women and Children's Hospital Affiliated to Chengdu Medical College, Chengdu 610041, China.

Chengdu Medical College, Chengdu 610500, China.

出版信息

Nan Fang Yi Ke Da Xue Xue Bao. 2022 Aug 20;42(8):1244-1249. doi: 10.12122/j.issn.1673-4254.2022.08.18.

Abstract

OBJECTIVE

To explore the effect of epidural labor analgesia duration on the outcomes of different anesthetic approaches for conversion to cesarean section.

METHODS

We retrospectively collected the clinical data of pregnant women undergoing conversion from epidural labor analgesia to cesarean section at Sichuan Maternal and Child Health Hospital and Jinjiang District Maternal and Child Health Care Hospital between July, 2019 and June, 2020. For cesarean section, the women received epidural anesthesia when the epidural catheter was maintained in correct position with effective analgesia, spinal anesthesia at the discretion of the anesthesiologists, or general anesthesia in cases requiring immediate cesarean section or following failure of epidural anesthesia or spinal anesthesia. Receiver-operating characteristic curve analysis was performed to determine the cutoff value of the analgesia duration using Youden index. The women were divided into two groups according to the cut off value for analyzing the relative risk using cross tabulations.

RESULTS

A total of 820 pregnant women undergoing conversion to cesarean section were enrolled in this analysis, including 615 (75.0%) in epidural anesthesia group, 186 (22.7%) in spinal anesthesia group, and 19 (2.3%) in general anesthesia group; none of the women experienced failure of epidural or spinal anesthesia. The mean anesthesia duration was 8.2±4.7 h in epidural anesthesia, 10.6±5.1 h in spinal anesthesia group, and 6.7 ± 5.2 h in general anesthesia group. Multivariate logistic regression analysis showed that prolongation of analgesia duration by 1 h (OR=1.094, 95% : 1.057-1.132, < 0.001) and an increase of cervical orifice by 1 cm (OR=1.066, 95% : 1.011-1.124, =0.017) were independent risk factors for epidural analgesia failure. The cutoff value of analgesia duration was 9.5 h, and beyond that duration the relative risk of receiving spinal anesthesia was 1.204 (95% : 1.103-2.341, < 0.001).

CONCLUSION

Prolonged epidural labor analgesia increases the risk of failure of epidural analgesia for conversion to epidural anesthesia. In cases with an analgesia duration over 9.5 h, spinal anesthesia is recommended if immediate cesarean section is not required.

摘要

目的

探讨硬膜外分娩镇痛时间对不同麻醉方式转剖宫产结局的影响。

方法

回顾性收集2019年7月至2020年6月在四川省妇幼保健院和锦江区妇幼保健院接受硬膜外分娩镇痛转剖宫产的孕妇临床资料。剖宫产时,硬膜外导管位置正确且镇痛有效时行硬膜外麻醉,麻醉医生酌情行脊麻,在需要紧急剖宫产或硬膜外麻醉或脊麻失败的情况下行全身麻醉。采用受试者工作特征曲线分析,用约登指数确定镇痛时间的截断值。根据截断值将产妇分为两组,用交叉表分析相对风险。

结果

本分析共纳入820例接受剖宫产的孕妇,其中硬膜外麻醉组615例(75.0%),脊麻组186例(22.7%),全身麻醉组19例(2.3%);所有产妇硬膜外或脊麻均未失败。硬膜外麻醉平均麻醉时间为8.2±4.7小时,脊麻组为10.6±5.1小时,全身麻醉组为6.7±5.2小时。多因素logistic回归分析显示,镇痛时间延长1小时(OR=1.094,95%:1.057 - 1.132,P<0.001)和宫颈口开大增加1cm(OR=1.066,95%:1.011 - 1.124,P = 0.017)是硬膜外镇痛失败的独立危险因素。镇痛时间的截断值为9.5小时,超过该时间接受脊麻的相对风险为1.204(95%:1.103 - 2.341,P<0.001)。

结论

延长硬膜外分娩镇痛会增加转硬膜外麻醉时硬膜外镇痛失败的风险。对于镇痛时间超过9.5小时且不需要紧急剖宫产的产妇,建议行脊麻。

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