期刊文献+

硬膜外分娩镇痛转行剖宫产术麻醉失败的相关因素分析 被引量:10

Related factors for failed conversion of epidural labor analgesia to cesarean delivery anesthesia
原文传递
导出
摘要 目的探讨硬膜外分娩镇痛中转剖宫产术麻醉失败的发生率以及失败的相关因素。方法回顾性纳入新疆医科大学第一附属医院2019年1月至2019年11月实施硬膜外分娩镇痛孕妇1143例。决定中转剖宫产后硬膜外腔给予1%利多卡因3 ml作为试验剂量,观察5 min后给予1%罗哌卡因7 ml,罗哌卡因使用后超过20 min未起效者为硬膜外麻醉失败,改用全身麻醉补救。收集产妇体重、身高、产次、ASA分级、硬膜外镇痛开始时宫口扩张情况、VAS疼痛评分、麻醉医师资历、实施椎管内阻滞技术细节、椎管内分娩镇痛持续时间、暴发疼痛时需要通过硬膜外导管单次追加药物的次数以及新生儿体重等;采用Logistic回归对硬膜外麻醉失败的相关因素进行综合分析,采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(aera under curve,AUC)图检验模型拟合效果。结果经阴道分娩失败后中转剖宫产243例,中转率为21.3%,硬膜外麻醉失败共计81(33.3%)例,暴发疼痛次数及硬膜外分娩镇痛持续时间>6 h对硬膜外麻醉效果影响差异有统计学意义(P<0.05)。Logistic回归分析显示,在硬膜外分娩镇痛持续时间>6 h方面,其比值比(odds ratio,OR)为0.536。当前模型的预测结果,其ROC AUC为0.789,与AUC为0.5的随机模型相比,当前模型的预测效果明显优于随机模型(P<0.05)。结论导致硬膜外分娩镇痛中转剖宫产麻醉失败与镇痛持续时间和镇痛效果不佳产妇主动增加药物剂量有关,可作为临床参考依据。 Objective To investigate the incidence of failed conversion of epidural labor analgesia to cesarean delivery anesthesia and related factors.Methods A total of 1143 pregnant women who underwent epidural labor analgesia in the First Affiliated Hospital of Xinjiang Medical University from January to November 2019 were retrospectively included.After conversion to cesarean delivery,3 ml of 1%lidocaine was given as a test dose in epidural space,and 7 ml of 1%ropivacaine was given after observation for 5 min.If ropivacaine did not exert effects 20 min after administration,it was considered as epidural anesthesia failure,and general anesthesia was used for remedy.Then,the following data were collected:weight,height,parity,American Society of Anesthesiologists(ASA)grade,dilatation of uterine orifice at the beginning of epidural analgesia,Visual Analogue Scale(VAS)score,the qualification of anesthesiologists,the details of intraspinal block,the duration of intraspinal labor analgesia,the times of single drug‑addition through epidural catheter when pain broke out,and neonatal weight.The related factors of epidural anesthesia failure were analyzed by Logistic regression.The area of receiver operating characteristic(ROC)curve was used to fit the effects.Results There were 243 pregnant women who were transferred to cesarean delivery after vaginal delivery failure,with a transfer rate of 21.3%,and 81(33.3%)of them showed epidural anesthesia failure.There were statistical differences in the effects of the number of pain outbreaks and the duration of epidural labor analgesia for more than 6 h on epidural anesthesia(P<0.05).Logistic regression analysis showed that,the odds ratio(OR)was 0.536 for the duration of epidural labor analgesia for more than 6 h.The prediction results of the current model showed that the ROC area under curve(AUC)was 0.789.Compared with the random model with AUC of 0.5,the prediction effect of the current model was significantly better than that of the random model(P<0.05).Conclusions The failed conversion of epidural labor analgesia to cesarean delivery anesthesia is related to the duration of analgesia and poor analgesia effect when pregnant women actively increase drug doses,which provides clinical evidence for future studies.
作者 艾来提·塔来提 郭海 洪毅 Ailaiti Talaiti;Guo Hai;Hong Yi(Department of Anesthesiology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China)
出处 《国际麻醉学与复苏杂志》 CAS 2021年第6期605-609,共5页 International Journal of Anesthesiology and Resuscitation
基金 新疆维吾尔自治区自然科学基金(2016D01C300)。
关键词 分娩镇痛 连续硬膜外麻醉 剖宫产术 Labor analgesia Continuous epidural anesthesia Cesarean delivery
  • 相关文献

参考文献2

二级参考文献29

  • 1Lumbiganon P,Laopaiboon M,Gulmezoglu AM,et al.Method of delivery and pregnancy outcomes in Asia:the WHO global survey on maternal and perinatal health 2007-08.Lancet,2010,375:490-499.
  • 2Burrows LJ,Meyn LA,Weber AM.Maternal morbidity associated with vaginal versus cesarean delivery.Obstet Gynecol,2004,103(5 Pt 1):907-912.
  • 3Althabe F,Sosa C,Belizán JM,et al.Cesarean section rates and maternal and neonatal mortality in low-,medium-,and high-income countries:an ecological study.Birth,2006,33:270-277.
  • 4Alvcs B,Sheikh A.Investigating the relationship between affluence and elective caesarean sections1.Br J Obstet Gynecol,2005,112:994-996.
  • 5曹泽毅.中华妇产科学.2版,北京:人民卫生出版社,2005:1373-1379.
  • 6Howell CJ. Epidural versus non-epidural analgesia for pain relief in labour. Cochrane Database Syst Rev, 2005, (4) : CD000331.
  • 7Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions 4.2.6. The Cochrane Collaboration, 2006.
  • 8Breen TW, Giesinger CM, Halpem SH. Comparison of epidural lidocaine and fentanyl to intrathecal sufentanil for analgesia in early labour. Int J Obstet Anesth, 1999, 8(4): 226-230.
  • 9Cooper GM, MacArthur C, Wilson M J, et al. COMET Study Group UK. Satisfaction, control and pain relief: short- and long-term assessments in a randomised controlled trial of low-dose and traditional epidurals and a non-epidural comparison group. Int J Obstet Anesth, 2010, 19(1 ) : 31-37.
  • 10Cortes CA, Sanchez CA, Oliveira AS, et al. Labor analgesia: a comparative study between combined spinal-epidura| anesthesia versus continuous epidural anesthesia. Rev Bras Anestesiol, 2007, 57(1): 39-51.

共引文献34

同被引文献126

引证文献10

二级引证文献28

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部