【摘要】 目的探讨缩短紧急剖宫产术从决定手术至胎儿娩出的时间(DDI),降低新生儿窒息率。方法对86例紧急剖宫产术患者,按病情紧急情况判断,启动5 min即刻剖宫产流程,如果威协产妇和胎儿生命者,采取全麻即刻剖宫产,如果对产妇和胎儿生命高度危险,但不威协母儿生命的情况,采用椎管内麻醉,有麻醉平面后行紧急剖宫产术。记录手术指征以及影响DDI的因素,不同DDI术后新生儿Apgar评分、脐动脉血气变化。结果 (1)施行紧急剖宫产术指征依次为:胎儿宫内窘迫40例(46%),活跃期停滞15例(17.4%),助产失败10例(11.6%),前置胎盘9例(10.0%),胎盘早剥6例(6.9%),脐带脱垂4例(4.6%),先兆子宫破裂2例(2.3%)。(2)DDI>5 min的影响因素依次为:送患者到达手术室慢36例(41.8%),急诊入院孕妇10例(13.5%),手术技术不熟练8例(10.8%),团队配合不默契7例(9.4%)。(3)不同DDI时间对新生儿影响:DDI≤5 min新生儿Apgar评分8~10分,脐动脉血p H(7.20±0.83),与≥5 min组新生儿Apgar评分比较差异具有统计学意义,P<0.01。结论针对紧急剖宫产术各个环节优化,有效缩短手术DDI时间,可降低新生儿窒息率。更多还原

【Abstract】 [Atracts] Objective To assess the reduce decision-to-delivery interval(DDI) in caesarean section, to decrease the rate of neonatal asphyxia. Methods 86 cases of caesarean sections were divided into two groups according to condition of emergency: the emergency caesarean sections with general anesthesia and the ones with spinal anesthesia. A retrospective study was performed in surgical indications, influential factors of DDI, neonatal Apgar score and umbilical arterial blood gas. Results(1)surgical indications were fetal distress(40 cases, 46.0%), protracted active phase(15 cases, 17.4%); delivery failure(10 cases, 16.2%); placenta praevia(9 cases, 10.0%);placental abruption(6 cases, 6.9%) omphaloproptosis(4 cases, 4.6%); threatened rupture of uterus(2 cases, 2.3%).(2)influential factors of DDI included the long time of taken to get the patient into operation room(36 cases, 41.8%); emergency hospital admission(14 cases, 16.2%); teamwork of not-tacit understanding(9 cases, 10.4%); not-skilled surgical technique(8 cases, 9.3%); others(20 cases, 23.0%).(3) Different DDI time effected on the newborn: if DDI was less than 5 min, neonatal Apgar score were 8~10, and umbilical artery blood were p H(7.20±0.83). Compared with the group whose DDI was more than 5 min, there was significant difference in neonatal Apgar score(P < 0.01).Concluslon For optimization all aspects of emergency cesarean section, effectively shorten DDI can reduce the rate of neonatal asphyxia.更多还原