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中华产科急救电子杂志

中华产科急救电子杂志 ›› 2020, Vol. 09 ›› Issue (01) : 54 -58. doi: 10.3877/cma.j.issn.2095-3259.2020.01.012

所属专题： 经典病例； 文献；

论著

孕期非产科手术87例围手术期管理及妊娠结局分析
吴亚芬1, 庹鹏1, 刘近发1, 王寿平1,†()   
  1. 1. 510150　广州医科大学附属第三医院麻醉科
  • 收稿日期:2019-07-01 出版日期:2020-02-18
  • 通信作者: 王寿平

Perioperative management and pregnancy outcome analysis for non-obstetric surgery during pregnancy: 87 case series

Yafen Wu1, Peng Tuo1, Jinfa Liu1, Shouping Wang1,†()   

  1. 1. Department of Anesthesiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong 510150, China
  • Received:2019-07-01 Published:2020-02-18
  • Corresponding author: Shouping Wang
  • About author:
    Corresponding author: Wang Shouping, Email:
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吴亚芬, 庹鹏, 刘近发, 王寿平. 孕期非产科手术87例围手术期管理及妊娠结局分析[J]. 中华产科急救电子杂志, 2020, 09(01): 54-58.

Yafen Wu, Peng Tuo, Jinfa Liu, Shouping Wang. Perioperative management and pregnancy outcome analysis for non-obstetric surgery during pregnancy: 87 case series[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2020, 09(01): 54-58.

目的

探讨孕妇在孕期行非产科手术时麻醉方式、手术因素及患者是否存在感染对母胎的影响。

方法

回顾性分析广州医科大学附属第三医院2015年1月至2018年8月收治的87例因非产科疾病行手术治疗孕妇的临床资料，分析患者疾病分类、最终分娩孕周、分娩方式、早产及流产率等妊娠结局，比较不同孕期、不同手术方式、麻醉方式及感染并发症对妊娠结局的影响。

结果

87例患者疾病分类：急性阑尾炎35例(40.2%)，宫内妊娠合并宫外孕7例(8.1%)，卵巢囊肿蒂扭转9例(10.3%)，卵巢肿物21例(24.1%)，泌尿系结石13例(14.9%)，胆囊结石2例(2.3%)；不同孕期接受非产科手术孕妇妊娠结局比较，差异无统计学意义(P>0.05)；不同手术方式孕妇的分娩孕周、分娩方式、流产率、早产率等方面比较，差异无统计学意义(P>0.05)；椎管内麻醉及全身麻醉在分娩方式、分娩孕周、早产及流产等方面比较，差异无统计学意义(P>0.05)。孕妇合并感染对妊娠结局有影响，孕妇合并感染情况对妊娠结局有影响，感染组分娩孕周低于对照组[(34.7±0.7)周与(38.5±0.2)周，Z＝5.088，P<0.05]。感染组剖宫产率、早产率和流产率均高于对照组[41.7% (10/24)与31.7% (20/63), χ2＝7.585；50% (12/24)与7.9% (5/63), χ2＝19.588；50.0% (12/24)与0, χ2＝29.659；P值均<0.05]。

结论

孕期行非产科手术仍然可以获得较满意的妊娠结局，对于病情稳定的患者，不同孕期进行手术、不同麻醉方式和不同手术方式对妊娠结局影响没有差别，但对于合并感染的患者，病情本身的进展可能会影响妊娠结局。

关键词: 妊娠, 非产科手术, 妊娠结局, 围术期管理, 麻醉
Objective

To investigate anesthesia methods, operation factors and infection factors effect on maternal and fetal outcome during non-obstetric surgery.

Methods

The clinical data of 87 pregnant women who needed surgical treatments for non-obstetric diseases from January 2015 to August 2018 in The Third Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. We documented their pregnancy outcome indexes such as gestational week, mode of delivery and premature birth rate. Then, the effects of different pregnancies, surgical methods, anesthetic methods and complications of infection on pregnant women′s were compared.

Results

There are 35 cases of acute appendicitis (40.2%), 7 cases of uterine pregnancy complicated with ectopic pregnancy (8.1%), 9 cases of ovarian cyst pedicle torsion (10.3%), 21 cases of ovarian mass (24.1%), 13 cases of Urinary calculi (14.9%) and 2 cases of cholecystolithiasis (2.3%). There were no significant differences in pregnancy outcome among pregnant women undergoing non-obstetric surgery during different pregnancies (P>0.05). There were no significant differences in mode of delivery, gestational age, abortion rate and premature delivery rate between laparoscopy group and abdomen group (P>0.05). There were no significant differences in mode of delivery, gestational age, premature delivery rate and abortion rate between intravertebral anesthesia group and general anesthesia group (P>0.05). The pregnant women with infection had an effect on the pregnancy outcome. The gestational age of the infected group was lower than that of the control group [(34.7±0.7) weeks vs (38.5±0.2) weeks, Z=5.088, P<0.05]. The incident rate of cesarean section, premature delivery and abortion in the infection group were all higher than those in the control group [41.7% (10/24) vs 31.7% (20/63), χ2=7.585; 50% (12/24) vs 7.9% (5/63), χ2=19.588; 50.0% (12/24) vs 0, χ2=29.659; all P<0.05].

Conclusions

Non-obstetric surgery during pregnancy still can achieve satisfactory pregnancy outcome in the stable patients, while different kind of anesthesia and operation in different gestation will not affect the safety of the puerperant and fetus, but the progress of the disease itself may affect the pregnancy outcome for the co-infection patient.

Key words: Pregnancy, Non-obstetric surgery, Pregnancy outcome, Perioperative management, Anaesthesia
表1 87例孕妇孕期合并非产科疾病分类、疾病情况及妊娠结局
疾病名称 例数(%) 诊断孕周(周) 术前体温例(℃) 白细胞计数(×109 /L)
急性阑尾炎 35(40.2%) 7＋～30＋ 2例(38.3 ℃)，余正常 7.3～18.3
宫内合并宫外妊娠 7(8.1%) 5＋～8＋ 正常 4.6～10.7
卵巢囊肿蒂扭转 9(10.3%) 5＋～31＋ 1例(37.5 ℃)，余正常 4.8～13.7
卵巢肿物 21(24.1%) 6＋～24＋ 正常 3.8～12.6
泌尿系结石 13(14.9%) 14＋～34＋ 2例(38.2 ℃)，余正常 10.5～33.1
胆囊结石 2(2.3%) 22＋～25＋ 正常 14.6～18.2
疾病名称 术中所见 SIRS评分(分) 分娩孕周(周) 分娩方式(例) 流产(例) 早产(例)
剖宫产 顺产
急性阑尾炎 8例坏疽穿孔性阑尾炎 2～4 34＋～37＋ 2 2 4 3
  27例水肿充血性阑尾炎 0～3 36＋～40＋ 9 18 0 4
宫内合并宫外妊娠 1例腹腔积血300 ml 0～2 37＋～41＋ 2 5 0 0
卵巢囊肿提扭转 1例坏死 0～2 33＋～40＋ 3 6 0 2
卵巢肿物 2例恶性 0 39＋～39＋ 2 0 0 0
  19例良性 0～4 18＋～41＋ 4 14 1 1
泌尿系结石 10例输尿管梗阻 1～4 28＋～38＋ 8 0 5 7
胆囊结石 胆囊水肿充血 2～3 39＋ 0 2 0 0
表2 87例孕妇不同孕期进行手术妊娠结局的比较
孕期分期 例数 分娩孕周(周) (±s) 分娩方式(例) 早产[例(%)] 流产[例(%)]
剖宫产 顺产
孕早期 21 38.4±0.4 6 13 1(4.8) 2(9.5)
孕中期 52 37.9±0.4 18 26 10(19.2) 8(15.4)
孕晚期 14 36.6±0.9 6 8 6(42.9) 0
统计值   Z＝0.864 χ2＝0.760 χ2＝7.762 χ2＝2.672
P值   >0.05 >0.05 >0.05 >0.05
表3 87例孕妇非产科手术不同手术方式妊娠结局的比较
手术方式 例数 分娩孕周(周) (±s) 分娩方式(例) 早产[例(%)] 流产[例(%)]
剖宫产 顺产
腹腔镜 24 38.6±0.4 5 17 1(4.2) 2(8.3)
开腹 63 37.5±0.3 25 30 16(25.4) 8(12.7)
统计值   Z＝2.247 χ2＝2.733 χ2＝3.723 χ2＝0.263
P值   >0.05 >0.05 >0.05 >0.05
表4 87例孕妇非产科手术不同麻醉方式妊娠结局的比较
麻醉方式 例数 分娩孕周(周) (±s) 分娩方式(例) 早产[例(%)] 流产[例(%)]
剖宫产 顺产
椎管内 46 37.7±0.3 17 25 11(23.9) 4(8.7)
全麻 41 37.9±0.5 13 22 6(14.6) 6(14.6)
统计值   Z＝1.283 χ2＝0.092 χ2＝1.187 χ2＝0.751
P值   >0.05 >0.05 >0.05 >0.05
表5 感染并发症对妊娠结局的影响
病情程度 例数 分娩孕周(周) (±s) 分娩方式[例(%)] 早产[例(%)] 流产[例(%)]
剖宫产 顺产
感染组 24 34.7±0.7 10(41.7) 4(16.7) 12(50.0) 10(41.7)
对照组 63 38.5±0.2 20(31.7) 43(68.3) 5(7.9) 0
统计值   Z＝5.088 χ2＝7.585 χ2＝19.588 χ2＝29.659
P值   <0.05 <0.05 <0.05 <0.05
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