剖宫产术中全身麻醉与腰麻的比较：准对照试验
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剖宫产术中全身麻醉与腰麻的比较：准对照试验
翻译：唐剑 编辑：冯玉蓉 审校：曹莹
背景：剖宫产通常采用全身麻醉或腰麻。本研究的目的是比较这两种麻醉方式下剖宫产的结果。
方法：在这项准对照试验中，我们招募了在加沙地带Al-Helal Al-Emirati医院进行剖宫产的产妇。患者分为全身麻醉(静脉注射20%异丙酚用于麻醉诱导，然后阿曲库铵用于肌肉松弛，氧化亚氮和氧气用于麻醉维持)或腰麻(0.5%重比重布比卡因和20 μg芬太尼鞘内注射)。观察指标包括住院时间、手术时间、术后1小时疼痛视觉模拟评分(VAS 0-10，其中0表示无疼痛，10表示极度疼痛)，麻醉开始至需要镇痛的时间，24小时内镇痛药物用量，以及术后的头痛发生率。数据采用SPSS软件进行分析。各组间采用Mann-Whitney U检验、t检验和比值比进行比较。p值小于0.05表示差异具有显著性。本研究经医院伦理委员会批准，并获得每位参与者的口头知情同意。
结果：181名产妇(年龄19-46.5岁)被纳入本研究。79名患者接受全身麻醉，102名患者接受腰麻。这些患者在基线特征上没有差异，例如平均年龄(全麻组30.6岁[SD6.5]vs腰麻组28.5岁[5.4]；P=0.077)以及体重(82.2 kg[SD14.2]vs28.5 kg[5.4]；P=0.263)。我们发现两组在住院时间(38·7h[SD 14·5]vs 40·1 h[12·5]；P=0·541)、手术时间(39·9 min[SD 10·1]vs 41·6 min[9·1]；P=0·077)、需要镇痛的时间(2·4 h[SD 2·0]vs 2·5 h[1·1]；P=0·634)和再入院率(odds ratio 0·77, 95% CI 0·11–5·59)方面没有差异。术后1h VAS全麻组高于腰麻组(5.43[SD2.9]vs 2.38[2.32]；P=0.001)。与腰麻组患者相比，需要第二和第三种镇痛药的全身麻醉患者较少(全身麻醉组中23%的患者需要两种镇痛药，而腰麻组中47%的患者需要两种镇痛药；4% VS 27%需要三种或更多止痛药；P< 0.0001)。腰麻组有2例患者术后出现头痛(OR 0.559，95% CI 0.490-0.636)。
结论：全身麻醉和腰麻有相似的安全性，可以根据患者的需要和医院的医疗情况进行应用。
文献来源：Tafish R, El Aish KIA, Madi W. General versus spinal anaesthesia for caesarean section:a quasi-controlled trial. The lancet,2019.DOI：10.1016/S0140-6736(18)30399-4 .
General versus spinal anaesthesia for caesarean section:a quasi-controlled trial
Summary
BACKGROUND:General anaesthesia and spinal anaesthesia are commonly used for caesarean sections. The aim of this study was to compare the outcomes from caesarean sections with these two types of anaesthesia.
METHODS:In this quasi-controlled trial, we enrolled women undergoing caesarean sections at Al-Helal Al-Emirati Hospital, Rafah, Gaza Strip. Women were assigned either to general anaesthesia (20% intravenous propofol for anaesthesia induction followed by atracurium for muscle relaxation, and nitrous oxide and oxygen for anaesthesia maintenance) or to spinal anaesthesia (0·5% hyperbaric solution bupivacaine with 20 μg fentanyl intrathecally). Outcome measures were length of hospital stay, length of operation, postoperative pain assessment by visual analogue scales (VAS; range 0-10, where 0 is no pain and 10 is very bad pain) 1 hour after the operation, time from anaesthesia to demand for analgesia, amount of analgesics used in 24 h, and headache after the operation. Data were analysed using SPSS version 20. Groups were compared using the Mann-Whitney U-test, Student's t test, and odds ratio. A p value less than 0·05 was significant. The study was approved by the hospital ethics committee, and verbal informed consent was obtained from each participant.
FINDINGS:181 women (aged 19-46·5 years) were enrolled in this study. 79 women received general anaesthesia, and 102 women received spinal anaesthesia. The women did not differ in baseline characteristics such as mean age (30·6 years [SD 6·5] in the general anaesthesia group vs 28·5 years [5·4] in the spinal anaesthesia group; p=0·077), and weight (82·2 kg [SD 14·2] vs 28·5 kg [5·4]; p=0·263). We found no difference between the groups in length of hospital stay (38·7 h [SD 14·5] vs 40·1 h [12·5]; p=0·541), duration of caesarean section (39·9 min [SD 10·1] vs 41·6 min [9·1]; p=0·077), time to demand for analgesia (2·4 h [SD 2·0] vs 2·5 h [1·1]; p=0·634), and hospital readmission (odds ratio 0·77, 95% CI 0·11-5·59). VAS 1 h after the operation was higher in the general anaesthesia group than in spinal anaesthesia group (5·43 [SD 2·9] vs 2·38 [2·32]; p=0·001). Fewer patients who had general anaesthesia needed second and third analgesics than patients who had spinal anaesthesia (23% of women in the general anaesthesia group vs 47% of women in spinal anaesthesia group needed two analgesics; 4% vs 27% needed three or more analgesics; p<0·0001). Two patients in the spinal anaesthesia group had headache after the operation (OR 0·559, 95% CI 0·490-0·636).
INTERPRETATION:General and spinal anaesthesia had a similar safety profile and can be applied according to patients' needs and medical situation in the hospital.
贵州医科大学高鸿教授课题组
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