【原】【罂粟摘要】1类剖宫产术麻醉类型与新生儿预后的关系：一项回顾性队列研究

1类剖宫产术麻醉类型与新生儿预后的关系：一项回顾性队列研究

贵州医科大学   麻醉与心脏电生理课题组

翻译：文春雷   编辑：柏雪   审校：曹莹

目的：椎管内麻醉是剖宫产的首选麻醉方式，因为它可以降低不良事件的风险。然而，急诊剖宫产常采用全身麻醉，以缩短胎儿娩出时间。本研究的目的是确定1类剖宫产患者将硬膜外分娩镇痛转化为手术麻醉是否与显著的新生儿发病率相关。

研究设计：这是一项回顾性队列研究，研究对象为2016年8月至2021年7月期间在一家学术三级护理机构的接受1类剖宫产产妇。主要结果是新生儿发病率，定义为新生儿脐带动脉血pH < 7.10和/或5分钟Apgar评分<7，和/或新生儿进入重症监护室。采用多变量回归分析，以控制协变量，并检查它们对结果的影响。

结果：共有185对母婴符合纳入条件，其中23例全麻剖宫产，162例硬膜外麻醉剖宫产。与硬膜外麻醉相比，全身麻醉下的1类剖宫产术的新生儿不良结局无显著差异（47% vs 35%，p = 0.3）。全身麻醉组脐带动脉血pH < 7.10的发生率高于硬膜外麻醉组（35% vs 12%，p = 0.018）。多变量回归模型表明，小胎龄（OR = 0.63；95% CI = 0.51-0.75，p = <0.001）和胎心异常（OR = 0.18；95% CI = 0.05-0.58，p = 0.005）是新生儿不良结局的显著预测因素。

结论：我们的结果表明，硬膜外镇痛转化为手术麻醉的1类剖宫产与较差的新生儿预后无关。

原始文献来源：Carl M. Skoog , Joel F. Katzer , Linder H. Wendt,et al.The Association of Anesthesia Type and Neonatal Outcomes Following Category-1 Cesarean

Delivery: A Retrospective Cohort Study,2023,15（3）:e35910.

英文原文：

The Association of Anesthesia Type and Neonatal

Outcomes Following Category-1 Cesarean

Delivery: A Retrospective Cohort Study

Objectives

Neuraxial anesthesia is the preferred anesthesia technique for cesarean delivery due to a decreased risk of adverse events. However, general anesthesia is often employed during emergent cesarean deliveries to achieve a shorter decision-to-delivery interval. The objective of this study was to determine if the conversion of epidural labor analgesia to surgical anesthesia for a category-1 cesarean delivery is associated with significant neonatal morbidity.

Study design

This was a retrospective cohort study of all intrapartum category-1 cesarean deliveries performed at an academic tertiary care institution between August 2016 and July 2021. The primary outcome was neonatal morbidity, defined as a composite of neonatal umbilical artery pH < 7.10 and/or 5‐min Apgar score < 7,and/or neonatal intensive care unit admission. A multivariate regression analysis was performed to control for the presence of covariates and examine the degree to which they influenced the outcome.

Results

A total of 185 mother-neonate pairs qualified for inclusion, of which 23 had cesarean delivery under general anesthesia and 162 under epidural anesthesia. There was no significant difference in adverse neonatal outcomes between category-1 cesarean deliveries done under general anesthesia compared to epidural anesthesia (47% vs 35%, p = 0.3). The incidence of umbilical arterial pH < 7.10 was higher in the general anesthesia group compared to the epidural anesthesia group (35% vs 12%, p = 0.018). The multivariate

regression model showed that gestational age (OR = 0.63; 95% CI = 0.51-0.75, p = <0.001) and non-reassuring fetal heart trace (OR = 0.18; 95% CI = 0.05-0.58, p = 0.005) were significant predictors of adverse neonatal outcome.

Conclusion

Our results suggest that the conversion of epidural analgesia to surgical anesthesia for category-1 cesarean delivery in women with a functional labor epidural catheter is not associated with poorer neonatal outcomes.

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