A comparative study on the effect of different anesthesia methods on early postoperative inflammatory indicators and rehabilitation in patients undergoing cesarean section
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摘要:
目的 评价不同麻醉方法对剖宫产产妇术后炎症标志物及康复的影响，为剖宫产手术选择麻醉方式提供参考。 方法 选取2022年1月—2023年5月中国科学技术大学附属第一医院南区急诊剖宫产产妇1 759例，根据麻醉方式分为全身麻醉组(G组，200例)和硬膜外麻醉组(E组，1 559例)，按纳入排除标准及倾向性评分法1∶1匹配后比较2种麻醉方法对患者术后白细胞(WBC)、血小板与淋巴细胞比率(PLR)、中性粒细胞与淋巴细胞比率(NLR)、单核细胞与淋巴细胞比率(MLR)及康复的影响。 结果 E组患者术后WBC、NLR及MLR较术前明显升高(均P＜0.05), G组患者术后WBC、PLR、NLR及MLR较术前均明显升高(P＜0.05)。与E组相比，G组手术前后PLR差值[16.78(0.16, 29.36)vs.-2.20(-21.69, 15.17)]升高(P＜0.05)。与E组比较，G组患者麻醉开始到胎儿娩出时间[6(3, 12)min vs.43(32, 54)min]和切皮到胎儿娩出时间[3(2, 7)min vs.7(6, 12)min]均缩短(P＜0.05)，术后肠道通气时间[44(39, 46)h vs.39(36, 43)h]延长(P＜0.05)。切皮前5 min和切皮时E组的MAP和HR均明显低于G组(P＜0.05)。2组患者术中出血量及术后住院时间比较差异均无统计学意义(P>0.05)。 结论 硬膜外麻醉可能更利于产妇康复，全身麻醉适合需紧急娩出胎儿的情况。 -
关键词:
- 剖宫产术 /
- 麻醉方法 /
- 血小板与淋巴细胞比率 /
- 中性粒细胞与淋巴细胞比率 /
- 单核细胞与淋巴细胞比率
Abstract:Objective To evaluate the effects of different anaesthetic methods on inflammatory markers and rehabilitation after caesarean section, and provide a reference for the selection of anaesthetic methods for caesarean section surgery. Methods A total of 1 759 patients undergoing emergency caesarean section in the Southern District of the First Affiliated Hospital of the University of Science and Technology of China from January 2022 to May 2023 were divided into general anaesthesia group (group G, n=200) and epidural anaesthesia group (group E, n=1 559). The parturients were selected according to specific inclusion and exclusion criteria, and then the parturients in the two groups were matched in a 1∶1 ratio using the propensity score method. The effects of two different anaesthetic methods on white blood cell (WBC), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and postoperative rehabilitation were compared. Results WBC, NLR and MLR in group E were significantly higher than those before surgery, while WBC, PLR, NLR and MLR in group G were significantly higher than those before surgery. Compared with group E, the difference of PLR before and after surgery in group G [16.78 (0.16, 29.36) vs.-2.20 (-21.69, 15.17)] was significantly higher (P < 0.05). In group G, the time from induction of anaesthesia to fetal delivery [6 (3, 12) min vs. 43 (32, 54) min] and the time from skin incision to fetal delivery [3 (2, 7) min vs. 7 (6, 12) min] were significantly shortened, whereas the postoperative farting time [44 (39, 46) h vs. 39 (36, 43) h] was significantly longer (P < 0.05). At 5 minutes before skin incision and during skin incision, group E had significantly lower MAP and HR compared to group G (P < 0.05). There were no significant differences in intraoperative blood loss and postoperative hospital stay between the two groups (P>0.05). Conclusion Epidural anaesthesia may be more beneficial for the mother' s recovery, while general anaesthesia is appropriate for emergency delivery of the fetus. -
表 1 匹配前2组剖宫产产妇一般情况比较
Table 1. Comparison of the general situation of the two groups of parturients undergoing cesarean section before matching
项目 G组(n=30) E组(n=1 171) 统计量 P值 年龄(x±s，岁) 32.3±3.6 31.8±4.0 0.756a 0.450 孕周(x±s，周) 38.8±1.2 39.0±1.0 0.805a 0.421 分娩次数[例(%)] 0.093b 0.760 1次 17(56.7) 696(59.4) ＞1次 13(43.3) 475(40.6) 胎儿窘迫[例(%)] 0.999c 是 1(3.3) 55(4.7) 否 29(96.7) 1 116(95.3) 胎膜早破[例(%)] 7.120b 0.008 是 10(33.3) 166(14.2) 否 20(66.7) 1 005(85.8) 胎盘早剥[例(%)] 0.001c 是 3(10.0) 3(0.3) 否 27(90.0) 1 168(99.7) 前置胎盘[例(%)] 0.027c 是 3(10.0) 24(2.0) 否 27(90.0) 1 147(98.0) 妊娠期糖尿病[例(%)] 0.057b 0.812 是 7(23.3) 252(21.5) 否 23(76.7) 919(78.5) 妊娠合并甲减[例(%)] 0.999c 是 3(10.0) 106(9.1) 否 27(90.0) 1 065(90.9) 妊娠合并甲亢[例(%)] 1.931b 0.165 是 0 105(9.0) 否 30(100.0) 1 066(91.0) 妊娠期高血压[例(%)] 0.999c 是 1(3.3) 56(4.8) 否 29(96.7) 1 115(95.2) 子痫[例(%)] 0.235b 0.628 是 2(6.7) 39(3.3) 否 28(93.3) 1 132(96.7) 注：a为t值，b为χ2值，c为采用Fisher精确检验。 
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表 2 匹配后2组剖宫产产妇一般情况比较
Table 2. Comparison of the general situation of the two groups of parturients undergoing cesarean section after matching
项目 G组(n=27) E组(n=27) 统计量 P值 年龄(x±s，岁) 32.5±3.7 31.7±3.7 0.848a 0.400 孕周(x±s，周) 38.8±1.2 38.6±1.0 0.442a 0.660 分娩次数[例(%)] 0.300b 0.584 1次 14(51.9) 16(59.3) ＞1次 13(48.1) 11(40.7) 胎儿窘迫[例(%)] 0.999c 是 1(3.7) 0 否 26(96.3) 27(100.0) 胎膜早破[例(%)] 0.092b 0.761 是 8(29.6) 7(25.9) 否 19(70.4) 20(74.1) 胎盘早剥[例(%)] 0.999c 是 1(3.7) 1(3.7) 否 26(96.3) 26(96.3) 前置胎盘[例(%)] 0.999c 是 2(7.4) 2(7.4) 否 25(92.6) 25(92.6) 妊娠期糖尿病[例(%)] 0.386b 0.535 是 6(22.2) 8(29.6) 否 21(77.8) 19(70.4) 妊娠合并甲减[例(%)] 0.270b 0.603 是 3(11.1) 1(3.7) 否 24(88.9) 26(96.3) 妊娠合并甲亢[例(%)] 0.999c 是 0 0 否 27(100.0) 27(100.0) 妊娠期高血压[例(%)] 0.999c 是 1(3.7) 0 否 26(96.3) 27(100.0) 子痫[例(%)] 0.999c 是 2(7.4) 2(7.4) 否 25(92.6) 25(92.6) 注：a为t值，b为χ2值，c为采用Fisher精确检验。
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表 3 2组剖宫产产妇手术前后血常规各项指标比较[M(P25, P75)]
Table 3. Comparison of blood routine indexes between the two groups of parturients before and after cesarean section[M(P25, P75)]
组别 例数 WBC(109/L) PLR 术前 术后 前后差值 术前 术后 前后差值 E组 27 7.91(6.97, 8.68) 9.49(8.35, 12.47)a 2.29(1.15, 3.18) 117.68(109.84, 158.49) 125.00(102.25, 174.47) -2.20(-21.69, 15.17) G组 27 7.81(6.92, 9.83) 9.60(8.31, 13.82)b 2.11(-0.66, 4.21) 117.24(85.60, 185.12) 127.88(106.84, 187.50)b 16.78(0.16, 29.36) Z值 -1.687 -0.493 -0.787 -2.483 P值 0.092 0.622 0.431 0.013 组别 例数 NLR MLR 术前 术后 前后差值 术前 术后 前后差值 E组 27 3.94(3.29, 5.39) 5.11(4.54, 7.44)a 1.41(-0.32, 2.83) 0.29(0.27, 0.39) 0.41(0.35, 0.49)a 0.11(0.03, 0.18) G组 27 5.08(3.59, 6.17) 6.89(5.05, 10.02)b 1.44(-0.35, 3.54) 0.35(0.29, 0.48) 0.55(0.42, 0.68)b 0.10(0.03, 0.31) Z值 -1.877 -0.268 -1.799 -0.424 P值 0.061 0.789 0.072 0.672 注：与E组术前比较，aP＜0.05；与G组术前比较，bP＜0.05。前后差值表示术后与术前该指标的差值。
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表 4 2组剖宫产产妇手术时间、胎儿娩出时间、术后肠道通气时间及住院时间比较[M(P25, P75)]
Table 4. Comparison of operation time, fetal delivery time, postoperative fart time and hospitalization time between two groups of parturients undergoing cesarean section[M(P25, P75)]
组别 例数 T手(min) T麻-娩(min) T切-娩(min) T肠(h) T住(d) E组 27 65(55, 82) 43(32, 54) 7(6, 12) 39(36, 43) 4(4, 4) G组 27 68(55, 85) 6(3, 12) 3(2, 7) 44(39, 46) 4(3, 4) Z值 0.364 -6.277 -3.635 -2.402 -1.503 P值 0.716 ＜0.001 ＜0.001 0.016 0.133
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表 5 2组剖宫产产妇不同时间MAP及HR比较(x±s)
Table 5. Comparison of MAP and HR at different time points between two groups of parturients undergoing cesarean section(x±s)
组别 例数 MAP(mmHg) HR(次/min) T0 T1 T2 T3 T0 T1 T2 T3 E组 27 93.48±8.26 83.78±8.27 81.70±8.51 87.15±6.61 92.52±13.25 79.15±8.77 75.67±9.29 92.93±13.70 G组 27 94.13±16.22 92.89±13.97 92.93±13.35 91.22±11.89 85.41±14.04 88.52±12.95 86.22±14.35 84.33±14.17 t值 0.137 8.498 13.569 2.422 3.664 9.694 10.302 5.132 P值 0.713 0.005 0.001 0.126 0.061 0.003 0.002 0.028
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表 6 2组剖宫产产妇术中出血量及新生儿Apgar评分比较[M(P25, P75)]
Table 6. Comparison of intraoperative blood loss and newborn Apgar scores between two groups of parturients undergoing cesarean section[M(P25, P75)]
组别 例数 出血量(mL) Apgar评分(分) 1 min 5 min E组 27 300(200, 400) 10(10, 10) 10(10, 10) G组 27 300(300, 400) 10(9, 10) 10(10, 10) Z值 -0.423 -2.826 -0.730 P值 0.672 0.005 0.466
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