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不同麻醉方法对剖宫产术后早期血常规炎症指标及康复的影响比较

郑客松 康芳 韩明明 杨成伟 黄祥 李娟

郑客松, 康芳, 韩明明, 杨成伟, 黄祥, 李娟. 不同麻醉方法对剖宫产术后早期血常规炎症指标及康复的影响比较[J]. 中华全科医学, 2024, 22(1): 34-38. doi: 10.16766/j.cnki.issn.1674-4152.003325
引用本文: 郑客松, 康芳, 韩明明, 杨成伟, 黄祥, 李娟. 不同麻醉方法对剖宫产术后早期血常规炎症指标及康复的影响比较[J]. 中华全科医学, 2024, 22(1): 34-38. doi: 10.16766/j.cnki.issn.1674-4152.003325
ZHENG Kesong, KANG Fang, HAN Mingming, YANG Chengwei, HUANG Xiang, LI Juan. A comparative study on the effect of different anesthesia methods on early postoperative inflammatory indicators and rehabilitation in patients undergoing cesarean section[J]. Chinese Journal of General Practice, 2024, 22(1): 34-38. doi: 10.16766/j.cnki.issn.1674-4152.003325
Citation: ZHENG Kesong, KANG Fang, HAN Mingming, YANG Chengwei, HUANG Xiang, LI Juan. A comparative study on the effect of different anesthesia methods on early postoperative inflammatory indicators and rehabilitation in patients undergoing cesarean section[J]. Chinese Journal of General Practice, 2024, 22(1): 34-38. doi: 10.16766/j.cnki.issn.1674-4152.003325

不同麻醉方法对剖宫产术后早期血常规炎症指标及康复的影响比较

doi: 10.16766/j.cnki.issn.1674-4152.003325
基金项目: 

安徽省自然科学基金项目 2108085MH323

详细信息
    通讯作者:

    李娟,E-mail:huamuzi1999@163.com

  • 中图分类号: R614  R719.8

A comparative study on the effect of different anesthesia methods on early postoperative inflammatory indicators and rehabilitation in patients undergoing cesarean section

  • 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。

     

  • 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
    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:at值,b为χ2值,c为采用Fisher精确检验。
    下载: 导出CSV

    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
    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:at值,b为χ2值,c为采用Fisher精确检验。
    下载: 导出CSV

    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 -1.687 -0.493 -0.787 -2.483
    P 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 -1.877 -0.268 -1.799 -0.424
    P 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。
    下载: 导出CSV

    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(min) T麻-娩(min) T切-娩(min) T(h) T(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 0.364 -6.277 -3.635 -2.402 -1.503
    P 0.716 <0.001 <0.001 0.016 0.133
    下载: 导出CSV

    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 0.137 8.498 13.569 2.422 3.664 9.694 10.302 5.132
    P 0.713 0.005 0.001 0.126 0.061 0.003 0.002 0.028
    下载: 导出CSV

    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 -0.423 -2.826 -0.730
    P 0.672 0.005 0.466
    下载: 导出CSV
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  • 收稿日期:  2023-08-03
  • 网络出版日期:  2024-03-09

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