南方医科大学学报

南方医科大学学报 ›› 2022, Vol. 42 ›› Issue (8): 1244-1249.doi: 10.12122/j.issn.1673-4254.2022.08.18

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硬膜外分娩镇痛时间对分娩镇痛中转剖宫产麻醉方式的影响

朱思颖，魏大源，张 丹，贾 飞，刘 波，张 健   

  1. 四川省妇幼保健院/成都医学院附属妇女儿童医院麻醉手术中心，妇女保健科，四川 成都 610041；成都医学院，四川 成都 610500；成都市锦江区妇幼保健院麻醉科，四川 成都 610011
  • 出版日期:2022-08-20 发布日期:2022-09-05

Prolonged epidural labor analgesia increases risks of epidural analgesia failure for conversion to cesarean section

ZHU Siying, WEI Dayuan, ZHANG Dan, JIA Fei, LIU Bo, ZHANG Jian   

  1. Department of Anesthesiology, Department of Women Health Care, Sichuan Provincial Maternity and Child Health Care Hospital/Women and Children's Hospital Affiliated to Chengdu Medical College, Chengdu 610041, China; Chengdu Medical College, Chengdu 610500, China; Department of Anesthesiology, Jinjiang Maternity and Child Health Care Hospital, Chengdu 610011, China
  • Online:2022-08-20 Published:2022-09-05

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摘要： 目的 探索硬膜外分娩镇痛时间对分娩镇痛中转剖宫产麻醉方式的影响。方法 回顾性收集2019年7月~2020年6月于四川省妇幼保健院、成都市锦江区妇幼保健院接受硬膜外分娩镇痛并中转剖宫产的孕妇临床资料，根据剖宫产麻醉方式分组：硬膜外导管位置正确且镇痛良好则行硬膜外麻醉（硬膜外组），脊髓麻醉在麻醉医生综合判断后实施（脊髓组），即刻剖宫产以及硬膜外麻醉或脊髓麻醉失败选择全身麻醉（全麻组）。多因素Logistic逐步回归分析用于寻找影响中转剖宫产麻醉方式的风险因素。使用镇痛时间构建受试者工作曲线，通过Youden指数确定镇痛时间临界值，按临界值将孕妇分为两组，利用交叉表计算各组的相对危险度。结果 研究共纳入820例孕妇，其中硬膜外组615例（75.0%）、脊髓组186例（22.7%）、全麻组19例（2.3%）均为即刻剖宫产，无硬膜外麻醉或脊髓麻醉失败改为全身麻醉病例。硬膜外组镇痛时间8.2±4.7 h，脊髓组镇痛时间10.6±5.1 h，全麻组镇痛时间6.7±5.2 h。Logistic回归分析显示：镇痛时间每延长1 h（OR=1.094，95% CI 1.057~1.132，P<0.001）、术前宫口每开大1 cm（OR=1.066，95% CI 1.011~1.124，P=0.017）是硬膜外麻醉失败的独立风险因素。镇痛时间临界值为9.5 h，镇痛时间超过临界值的孕妇接受脊髓麻醉的相对风险度为1.204（95% CI 1.103~2.341，P<0.001）。结论 镇痛时间延长会增加硬膜外麻醉失败的风险，对镇痛时间超过9.5 h的非即刻剖宫产建议选择脊髓麻醉。

关键词: 硬膜外分娩镇痛；镇痛时间；剖宫产；麻醉方式

Abstract: Objective To explore the effect of epidural labor analgesia duration on the outcomes of different anesthetic approaches for conversion to cesarean section. Methods We retrospectively collected the clinical data of pregnant women undergoing conversion from epidural labor analgesia to cesarean section at Sichuan Maternal and Child Health Hospital and Jinjiang District Maternal and Child Health Care Hospital between July, 2019 and June, 2020. For cesarean section, the women received epidural anesthesia when the epidural catheter was maintained in correct position with effective analgesia, spinal anesthesia at the discretion of the anesthesiologists, or general anesthesia in cases requiring immediate cesarean section or following failure of epidural anesthesia or spinal anesthesia. Receiver-operating characteristic curve analysis was performed to determine the cutoff value of the analgesia duration using Youden index. The women were divided into two groups according to the cut off value for analyzing the relative risk using cross tabulations. Results A total of 820 pregnant women undergoing conversion to cesarean section were enrolled in this analysis, including 615 (75.0%) in epidural anesthesia group, 186 (22.7%) in spinal anesthesia group, and 19 (2.3% ) in general anesthesia group; none of the women experienced failure of epidural or spinal anesthesia. The mean anesthesia duration was 8.2±4.7 h in epidural anesthesia, 10.6±5.1 h in spinal anesthesia group, and 6.7 ± 5.2 h in general anesthesia group. Multivariate logistic regression analysis showed that prolongation of analgesia duration by 1 h (OR=1.094, 95% CI: 1.057-1.132, P<0.001) and an increase of cervical orifice by 1 cm (OR=1.066, 95% CI: 1.011-1.124, P=0.017) were independent risk factors for epidural analgesia failure. The cutoff value of analgesia duration was 9.5 h, and beyond that duration the relative risk of receiving spinal anesthesia was 1.204 (95% CI: 1.103-2.341, P<0.001). Conclusion Prolonged epidural labor analgesia increases the risk of failure of epidural analgesia for conversion to epidural anesthesia. In cases with an analgesia duration over 9.5 h, spinal anesthesia is recommended if immediate cesarean section is not required.

Key words: epidural labor analgesia; analgesia duration; cesarean section; anesthesia method