Vincent R D, Martin R W
Department of Anesthesiology, University of Mississippi Medical Center, Jackson, USA.
Obstet Gynecol. 1996 Jul;88(1):119-22. doi: 10.1016/0029-7844(96)00118-4.
To determine the anesthetic and surgical morbidity associated with postpartum tubal ligation after pregnancy complicated by pregnancy-induced hypertension.
Preoperative hemodynamic measurements, laboratory results, choice of anesthetic technique, intraoperative hemodynamic changes, and postoperative morbidity were compared in 53 women with pregnancy-induced hypertension (hypertensive group) and 53 controls who underwent postpartum tubal ligation between October 1992 and November 1995. We used a retrospective case-control design.
Preoperative mean blood pressure (BP) measurements ( +/- standard deviation) were greater in hypertensive women than in controls (158 +/- 22/91 +/- 12 versus 126 +/- 13/71 +/- 10 mmHg; P < .001). Among women given spinal anesthetics for tubal ligation, the minimum intraoperative systolic BP was significantly lower in controls than in hypertensive women (P < .05). However, the maximum percentage decrease in systolic BP was greater in hypertensive women than in controls (33 +/- 14 versus 22 +/- 10%; P < .05). Only one patient in each group developed intraoperative hypertension. The percentage of patients discharged later than the first postoperative day was greater in hypertensive women than in controls (23 versus 8%; P < .05).
The lack of profound hemodynamic responses during spinal or general anesthesia for postpartum tubal ligation supports the continued use of this procedure in selected women with pregnancy-induced hypertension.
确定妊娠合并妊娠高血压综合征后行产后输卵管结扎术的麻醉及手术并发症。
比较1992年10月至1995年11月期间接受产后输卵管结扎术的53例妊娠高血压综合征患者（高血压组）和53例对照者的术前血流动力学测量值、实验室检查结果、麻醉技术选择、术中血流动力学变化及术后并发症。采用回顾性病例对照设计。
高血压组患者术前平均血压（血压值±标准差）高于对照组（158±22/91±12 mmHg与126±13/71±10 mmHg；P<.001）。在接受脊髓麻醉进行输卵管结扎的患者中，对照组术中最低收缩压显著低于高血压组患者（P<.05）。然而，高血压组患者收缩压的最大下降百分比高于对照组（33±14与22±10%；P<.05）。每组仅1例患者术中出现高血压。高血压组患者术后出院时间晚于术后第1天的百分比高于对照组（23%与8%；P<.05）。
产后输卵管结扎术采用脊髓麻醉或全身麻醉时血流动力学反应不剧烈，这支持在选定的妊娠高血压综合征患者中继续采用该手术。
