摘要
目的:分析分娩镇痛中硬膜外分娩镇痛时间对转剖宫产麻醉方式的影响。方法:回顾性分析2022年1月—2022年12月在我院行硬膜外分娩镇痛中转剖宫产的1484例孕妇的临床资料,根据麻醉方式不同分为硬膜外麻醉组、脊髓麻醉组。采用单因素及多因素分析剖宫产麻醉方式的因素,另依据硬膜外镇痛时间制作ROC曲线,依据最大约登指数明确硬膜外镇痛时间最佳临界值,并依据该值把孕妇分为硬膜外镇痛长程组、短程组,并比较两组孕妇的术中术后情况。结果:单因素分析显示,两组硬膜外镇痛时间、导管移位占比、术前人工破膜占比、术前宫口大小比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,硬膜外麻醉的有利因素是术前人工破膜(P<0.05);脊髓麻醉的有利因素是硬膜外镇痛时间、导管移位、术前宫口大(P<0.05)。ROC曲线分析显示,9.64 h是硬膜外镇痛时间最佳临界值,敏感度为0.599,特异性为0.906。长程组行脊髓麻醉的风险是短程组的2.805倍,差异有统计学意义(P<0.05)。硬膜外镇痛长程组发生术中低血压的概率高于短程组,差异有统计学意义(P<0.05)。结论:硬膜外麻醉、脊髓麻醉是硬膜外分娩镇痛中转剖宫产的主要麻醉方式,硬膜外镇痛时间、术前人工破膜、导管移位、术前宫口大可影响麻醉方式的选择,镇痛时间超过9.64 h的剖宫产孕妇以脊髓麻醉为主,且容易出现术中低血压,应做好预防工作。
Objective:To analyze the effect of epidural labor analgesia time on the anesthesia method of cesarean section.Methods:The clinical data of 1484 pregnant women who underwent epidural labor analgesia in our hospital from January 2022 to December 2022 were retrospectively analyzed.They were divided into epidural anesthesia group and spinal anesthesia group according to different anesthesia methods.Univariate and multivariate analysis were used to analyze the factors of cesarean section anesthesia.ROC curve was made according to epidural analgesia time,and the optimal critical value of epidural analgesia time was determined according to the maximum Youden index.According to this value,pregnant women were divided into long-term epidural analgesia group and short-term epidural analgesia group,and the intraoperative and postoperative conditions of the two groups were compared.Results:Univariate analysis showed that there were statistically significant differences in epidural analgesia time,proportion of catheter displacement,proportion of preoperative artificial rupture of membranes,and preoperative uterine orifice size between the two groups(P<0.05).Multivariate Logistic regression analysis showed that the favorable factor of epidural anesthesia was preoperative artificial rupture of membranes(P<0.05).The favorable factors for spinal anesthesia were epidural analgesia time,catheter displacement,and preoperative large cervix(P<0.05).ROC curve analysis showed that 9.64 h was the optimal critical value of epidural analgesia time,with sensitivity of 0.599 and specificity of 0.906.The risk of spinal anesthesia in the longterm group was 2.805 times that in the short-term group,and the difference was statistically significant(P<0.05).The incidence of intraoperative hypotension in the long-term epidural analgesia group was higher than that in the short-term group,and the difference was statistically significant(P<0.05).Conclusion:Epidural anesthesia and spinal anesthesia are the main anesthesia methods for epidural labor analgesia to transfer to cesarean section.Epidural analgesia time,preoperative artificial rupture of membrane,catheter displacement,and preoperative large cervix can affect the choice of anesthesia methods.Pregnant women with cesarean section whose analgesia time exceeds 9.64 h are mainly spinal anesthesia,and are prone to intraoperative hypotension,so prevention should be done.
作者
余可
孙慧
孙思华
江金霞
许琪
YU Ke;SUN Hui;SUN Sihua;JIANG Jinxia;XU Qi(Department of Anesthesiology,the People’s Hospital of Qichun County,Qichun 435300,Hubei,China)
出处
《中国药物滥用防治杂志》
CAS
2024年第1期18-22,共5页
Chinese Journal of Drug Abuse Prevention and Treatment
关键词
分娩镇痛
硬膜外
镇痛时间
中转剖宫产
麻醉方式
Labor analgesia
Epidural
Analgesic duration
Transfer caesarean section
Mode of anesthesia
