Sibai B M, Caritis S N, Thom E, Shaw K, McNellis D
Department of Obstetrics and Gynecology, University of Tennessee, Memphis, USA.
Am J Obstet Gynecol. 1995 May;172(5):1553-7. doi: 10.1016/0002-9378(95)90495-6.
Our purpose was to determine the frequency and safety of the use of epidural anesthesia and the correlation between bleeding time and maternal-neonatal bleeding complications in a group of pregnant women who participated in a multicenter trial of low-dose aspirin in pregnancy.
Data regarding type of anesthesia used for labor and delivery were available in 1629 nulliparous women who were randomly assigned at 13 to 27 weeks to receive 60 mg/day aspirin or a placebo. A total of 891 (55%) received epidural anesthesia, and the remaining 738 did not.
Among the 891 women known to have received epidural anesthesia, 451 were assigned to low-dose aspirin and 440 to placebo. There was no instance of bleeding related to epidural use. In addition, there were no differences in maternal and neonatal complications between those receiving or not receiving epidural anesthesia. Within the group receiving epidural anesthesia there were no differences in bleeding complications between those assigned to aspirin on placebo. One of the five centers also obtained bleeding times in 303 women (149 received aspirin and 154 received placebo). The mean +/- SD bleeding time in women assigned to low-dose aspirin was significantly higher than in women assigned to placebo (6.99 +/- 2.95 minutes vs 5.99 +/- 2.43 minutes, p = 0.004). In addition, the frequency of women having a bleeding time > 10 minutes was higher in the aspirin group (14.1% vs 5.2%, p = 0.01). Interestingly, women who received an epidural anesthetic had a lower bleeding time than those not receiving an epidural (p = 0.003), irrespective of the treatment used.
In women assigned to low-dose aspirin there were no adverse effects related to epidural anesthesia. In spite of an increased bleeding time in a subset of pregnant women assigned to low-dose aspirin, maternal-neonatal bleeding complications were not increased.
我们的目的是确定在一组参与孕期低剂量阿司匹林多中心试验的孕妇中，硬膜外麻醉的使用频率和安全性，以及出血时间与母婴出血并发症之间的相关性。
1629名未生育过的妇女参与了研究，她们在孕13至27周时被随机分配，分别接受60毫克/天的阿司匹林或安慰剂。关于分娩时所用麻醉类型的数据是可用的。其中891名（55%）接受了硬膜外麻醉，其余738名未接受。
在已知接受硬膜外麻醉的891名妇女中，451名被分配到低剂量阿司匹林组，440名被分配到安慰剂组。没有与硬膜外麻醉使用相关的出血情况。此外，接受或未接受硬膜外麻醉的妇女在母婴并发症方面没有差异。在接受硬膜外麻醉的组中，分配到阿司匹林或安慰剂的妇女在出血并发症方面没有差异。五个中心之一还对303名妇女（149名接受阿司匹林，154名接受安慰剂）进行了出血时间检测。分配到低剂量阿司匹林组的妇女的平均±标准差出血时间显著高于分配到安慰剂组的妇女（6.99±2.95分钟对5.99±2.43分钟，p = 0.004）。此外，阿司匹林组出血时间>10分钟的妇女频率更高（14.1%对5.2%，p = 0.01）。有趣的是，无论使用何种治疗方法，接受硬膜外麻醉的妇女的出血时间都比未接受硬膜外麻醉的妇女低（p = 0.003）。
在分配到低剂量阿司匹林的妇女中，没有与硬膜外麻醉相关的不良反应。尽管分配到低剂量阿司匹林的一部分孕妇出血时间延长，但母婴出血并发症并未增加。
