产妇体重指数和区域麻醉使用：患病率和并发症
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Maternal Body Mass Index and Regional Anaesthesia Use at Term:Prevalence and Complications
背景与目的
关于区域麻醉（硬膜外、脊髓或硬膜外/脊髓联合麻醉）和产妇体重指数（BMI）相关并发症的证据存在差异。我们研究了区域麻醉、分娩方式和在足月妊娠中不同BMI的区域麻醉并发症之间的关系。
方 法
利用相关的分娩证明和出院病人资料，回顾性队列研究了2007-2010年在加利福尼亚分娩的病人。选择分娩方式（在助产中）和区域麻醉的并发症。对产妇数据进行多变量泊松回归分析。
结 果
接受助产（即助产分娩）的妇女，BMI指数较高的女性更容易接受局部镇痛。（调整后的危险比[RR] 1.10，95%可信区间[CI] 1.10，1.11第一类肥胖初产妇），在这些接受区域麻醉的病人中，不太可能顺产（例如RR 0.85，95% CI 0.84，0.85的同类别女性)。区域麻醉并发症与母体体重指数呈复杂的关系，与体重正常妇女相比，中度肥胖妇女的并发症几率减少，BMI最高的女性患并发症的风险增加了两倍。（RR 2.34，95% CI 1.37，4.02初产妇女）。
结 论
较高BMI的助产分娩妇女与正常体重的妇女和没有区域麻醉的妇女相比，更可能接受区域麻醉，并且更可能通过剖腹产分娩。在BMI最高的妇女中，麻醉并发症的发生率最高。
原始文献摘要
Frances M. Biel, a Nicole E. Marshall, a Jonathan M. Snowden a,b et al. Maternal Body Mass Index and Regional Anaesthesia Use at Term:Prevalence and Complications John Wiley & Sons Ltd Paediatric and Perinatal Epidemiology, 2017doi: 10.1111/ppe.12387
Background: There is an evidence gap regarding the use of regional anaesthesia (epidural, spinal, or combined epidural/spinal anaesthesia) and associated
complications by maternal body mass index (BMI). We examine associations between regional anaesthesia, mode of delivery, and regional anaesthesia complications by prepregnancy BMI categories among term deliveries.
Methods: Retrospective cohort study of births in California, 2007-2010, utilizing linked birth certificate data and patient discharge data. Outcomes were mode of delivery (among laboured deliveries) and select regional anaesthesia complications. Multivariable Poisson regression was used to adjust for maternal characteristics.
Results: In women undergoing labour (i.e. laboured delivery), women with higher BMI categories were more likely to receive regional analgesia in a dose–response fashion (adjusted risk ratio [RR] 1.10, 95% confidence interval [CI]1.10, 1.11 for primiparous women with category I obesity), and in those receiving regional anaesthesia, were less likely to deliver vaginally (e.g. RR 0.85, 95% CI 0.84, 0.85 for the same category of women). Regional anaesthesia complications displayed a complex relationship with maternal BMI, with women in intermediate obesity categories having decreased odds as compared to normal-weight women, and women in the highest BMI category having a twofold increased risk of complications (RR 2.34, 95% CI 1.37, 4.02 for primiparous women).
Conclusion: Labouring women in higher BMI categories were more likely to receive regional anaesthesia and more likely to deliver via caesarean compared to normal weight women and women without regional anaesthesia.Rates of anaesthesia complications were highest among women in the highest BMI category.
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