本刊首页 > 期刊目次 > 血栓弹力图及血小板计数指导血小板减少性孕妇麻醉方案选择的一致性研究

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血栓弹力图及血小板计数指导血小板减少性孕妇麻醉方案选择的一致性研究

  • 郭志强,李钰艳,许斌

* 通信作者: 许斌, 单位:遂宁市中心医院麻醉科

摘要

摘要:
目的 研究血栓弹力图及血小板计数(PLC)对指导血小板减少症孕妇麻醉方式选择

结果的一致性,以指导基层医院制定麻醉方案。

方法 纳入2014年1月至2017年1月于我院接受剖宫产手术的124例妊娠期血小板减少孕妇为对象。首先根据术前PLC初步制定麻醉方案,按血小板计数划分为3组,PLC≥70×109/L孕妇(A组,31例)拟接受腰硬联合麻醉,PLC 30~70×109/L孕妇(B组,74例),其中无明显出血史孕妇采用腰硬联合包行单次腰麻,具备出血史孕妇采用全麻,PLC<30×109/L孕妇(C组,19例)拟接受全麻。麻醉前进一步根据血栓弹力图

结果确定是否需对麻醉方案进行调整。观察3组血栓弹力图特征,统计3组麻醉方案调整前情况,观察麻醉效果及新生儿及产妇情况。

结果 3组血栓弹力图指标对比,凝血时间呈A组最低,B组次之,C组最低趋势;最大振幅及α角均呈A组最高,B组次之,C组最低趋势,两两差异均有统计学意义(P<0.05)。4例患者根据血栓弹力图

结果调整麻醉方案,初选及调整后方案的符合率96.77%,kappa系数0.945(P<0.001)。C组新生儿出生1min Apgar评分明显低于A、B组,孕妇住院时间明显长于A、B组,差异有统计学意义(P<0.05)。

结论 血栓弹力图能有效反映血小板减少性孕妇凝血功能,以指导选择麻醉方案;如无法开展血栓弹力图检测,利用PLC指导血小板减少性孕妇麻醉方案的选择是可行的,其选择

结果与血栓弹力图选择

结果基本一致。

关键词:关键词:孕妇;血小板减少症;血小板计数;剖宫产术;麻醉

ABSTRACT

Abstract:
Objective To analyze the consistency of the guiding effect of platelet count and thrombus elasticity diagram on the selection of anesthesia program in pregnant women with thrombocytopenia, thus to guide primary hospital to set up anesthesia plan.

Methods 124 pregnant women with thrombocytopenia treated with cesarean section during January 2014 to January 2017 were enrolled. Anesthesia program was preliminary formulated according to PLC before surgery, these women were divided into 3 groups. Cases whose PLC ≥70×109/L (Group A, 31 cases) were plan to apply combined spinal epidural anesthesia. Cases whose PLC were between 30 and 70×109/L (Group B, 74 cases) were plan to apply subarachnoid space block anesthesia if without history of bleeding, were plan to apply general anesthesia if with history of bleeding. Cases whose PLC <30×109/L (Group C, 19 cases) were plan to apply general anesthesia. Before anesthesia, the anesthesia program were confirmed by thrombus elasticity diagram. The characteristics of thrombus elasticity diagram, the changes of anesthesia program, effect of anesthesia and neonatal and maternal conditions in 3 groups were observed and compared.

ResultsThe comparison of thrombus elasticity diagram indexes in 3 groups showed that, coagulation time was the shortest in A group, longer in group B and longest in group C, the maximum amplitude and αangle were the highest in A group, less in Group B and the least in Group C, the differences between each 2 groups were statistically significant (P<0.05). Anesthesia plan of 4 patients were adjusted according to thrombus elasticity diagram, the coincidence rate of the primary and adjusted scheme was 96.77%, and the kappa coefficient was 0.945 (P<0.001). The 1min Apgar scores of neonates in group C were significantly lower than that in group A and B, and the length of stay of pregnant women in Group C was longer than that in group A and B (P<0.05).

Conclusion   Thrombus elasticity diagram can effectively reflect the coagulation function of pregnant women with thrombocytopenia, so as to guide the selection of anesthesia program. For hospitals which can’t apply thrombus elasticity diagram, it is feasible to use PLC to guide the selection of anesthesia program for pregnant women with thrombocytopenia, the results are of high consistency with thrombus elasticity diagram.

Key words: Keywords:Pregnant women; Thrombocytopenia; Platelet count; Cesarean section; Anesthesia

引用本文 / How to Cite This Article

郭志强,李钰艳,许斌.血栓弹力图及血小板计数指导血小板减少性孕妇麻醉方案选择的一致性研究[J]. 国际精神病学杂志, , (): -

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