Albright G A, Forster R M
Bellevue Woman's Hospital, Niskayuna, New York, USA.
Reg Anesth. 1997 Sep-Oct;22(5):400-5. doi: 10.1016/s1098-7339(97)80025-9.
The purpose of this review was to determine if patients who receive combined spinal-epidural (CSE) analgesia with subarachnoid sufentanil have an increased incidence of emergency cesarean delivery for fetal distress when compared with patients who receive systemic or no medication (S/NM) for labor analgesia.
A retrospective computerized analysis of data on all 2,560 deliveries at Bellevue Woman's Hospital for 14 months summarized practice parameters for 1,240 patients who received regional analgesia (98% CSE analgesia), identified 1,140 patients who received S/NM, and classified the urgency of 479 cesarean deliveries. In the CSE group there were 168 cesarean deliveries (emergency 16, urgent 58, semiurgent 70, and nonurgent 24) as compared with a total of 128 (emergency 16, urgent 43, semiurgent 69, nonurgent 0) in the S/NM group. Scheduled cesarean sections (180) were excluded from the study.
The incidence of emergency cesarean delivery in 1,217 patients who received CSE analgesia with subarachnoid sufentanil (10-15 micrograms) compared with 1,140 patients who received S/NM for labor analgesia was 1.3% versus 1.4%, respectively. More importantly, there was no case in which emergency cesarean delivery was required for acute fetal distress in the absence of obstetric factors during the 90 minutes following administration of subarachnoid sufentanil. General anesthesia was required for emergency cesarean delivery in only one patient (6%) in the CSE group, as against eight patients (50%) in the S/NM group who required general anesthesia for emergency cesarean section (P < .05).
This experience indicates that patients who receive CSE analgesia do not have a higher incidence of emergency cesarean delivery than patients who have S/NM for labor analgesia. Emergency cesarean section for fetal distress within 90 minutes of the administration of intrathecal sufentanil only occurred in association with obstetric factors. However, caution should be exercised in extrapolating these results to other practice settings, particularly high-risk referral centers.
本综述的目的是确定与接受全身用药或未用药（S/NM）进行分娩镇痛的患者相比，接受蛛网膜下腔舒芬太尼联合腰麻-硬膜外联合阻滞（CSE）镇痛的患者因胎儿窘迫而行急诊剖宫产的发生率是否增加。
对贝尔维尤女子医院14个月内所有2560例分娩的数据进行回顾性计算机分析，总结了1240例接受区域镇痛（98%为CSE镇痛）患者的实践参数，确定了1140例接受S/NM的患者，并对479例剖宫产的紧急程度进行了分类。CSE组有168例剖宫产（急诊16例、紧急58例、半紧急70例、非紧急24例），而S/NM组共有128例（急诊16例、紧急43例、半紧急69例、非紧急0例）。择期剖宫产（180例）被排除在研究之外。
1217例接受蛛网膜下腔舒芬太尼（10 - 15微克）CSE镇痛的患者与1140例接受S/NM分娩镇痛的患者相比，急诊剖宫产的发生率分别为1.3%和1.4%。更重要的是，在蛛网膜下腔注射舒芬太尼后的90分钟内，在没有产科因素的情况下，没有因急性胎儿窘迫而需要急诊剖宫产的病例。CSE组仅1例（6%）急诊剖宫产需要全身麻醉，而S/NM组有8例（50%）急诊剖宫产需要全身麻醉（P < 0.05）。
该经验表明，接受CSE镇痛的患者急诊剖宫产的发生率并不高于接受S/NM分娩镇痛的患者。鞘内注射舒芬太尼后90分钟内因胎儿窘迫而行急诊剖宫产仅与产科因素有关。然而，将这些结果外推至其他实践环境时应谨慎，尤其是高危转诊中心。
