Minimally invasive spinal anesthesia for cesarean section in maternal anticoagulation therapy: a randomized controlled trial
Minimally invasive spinal anesthesia for cesarean section in maternal anticoagulation therapy: a randomized controlled trial
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微创椎管内麻醉用于剖宫产术中产妇抗凝治疗：一项随机对照试验
DOI：
10.1186/s12871-018-0679-1
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发表时间：
2019-01-12
影响因子：
2.2
通讯作者：
Zhou, Jie
中科院分区：
文献类型：
--
作者：
Huang, Dan;Zhu, Linjie;Zhou, Jie
背景孕期抗凝治疗由于人们对母体高凝状态的认识日益增强而得到广泛应用。很少有研究报道在这些产妇中使用微创脊麻。本研究的目的是评价微创腰麻用于剖宫产术后抗凝治疗的安全性和可行性。方法对239例接受抗凝治疗的剖宫产产妇进行随机对照研究。37例产妇停药，采用27G笔型细针(实验组，n= 110)和22G传统脊椎针(对照组，n= 92)进行腰麻。主要疗效结果为产后腰痛(LBP)和硬膜后穿刺性头痛(PDPH)。结果两组产妇均未发生∆，术后24、48、72 h背部穿刺点VAS(分别为24 h、48 h、72 h)，产妇满意度及住院天数。两组间VAS1BP-24 h、VASIBP-48 h、VASIBP-72 h差异无统计学意义(分别为P= 0.056、P= 0.813、P= 0.189)。实验组输精管硬膜外评分(P= 0.017)、∆评分(P= 0.001)、输精管硬膜外24 h评分(P<； 0.0001)较低，而产妇满意度较高(P= 0.046)。两组患者硬膜外-48 h、硬膜外-72 h、排尿功能、力量恢复、住院天数((P= 0.069；P= 0.667；P= 0.105；P= 0.133；P= 0.754，)差异无统计学意义。结论微创腰麻硬膜外麻醉时间较短，硬膜外-24 h较硬膜外麻醉，产妇满意度较高。因此，在血小板计数和凝血时间正常的剖宫产产妇抗凝治疗中，它被认为是安全、可靠和合理的选择。试验登记本研究于2016年11月11日在www.Clinicaltrials.gov注册(NCT02987192)。
BackgroundAnticoagulant therapy during pregnancy is widely used due to the increasing awareness of maternal hypercoagulability. Few studies have reported the use of minimally invasive spinal anesthesia in these parturients. The objective of this study was to evaluate the safety and feasibility of minimally invasive spinal anesthesia in parturients with anticoagulation therapy undergoing cesarean section.MethodsThis was a randomized, controlled study conducted in 239 parturients using anticoagulants and undergoing selective cesarean section. 37 parturients withdrew, and finally parturients received spinal anesthesia using 27gauge pen type fine spinal needles (experimental group,n= 110) and 22gauge traditional spinal needles (control group,n= 92). The primary efficacy outcomes included low back pain (LBP) and postdural puncture headache (PDPH) after delivery. Secondary efficacy outcomes included visual analogue scale during subarachnoid puncture (VASdural), difference between visual analogue scale (VAS) during peripheral venipuncture and VASdural (∆VAS), VAS of back puncture point 24, 48 and 72 h after operation (VASdural-24 h, VASdural-48 h and VASdural-72 h, respectively), maternal satisfaction and hospitalization stay.ResultsNo parturient had PDPH and was suspected with spinal or intracranial haematoma in two groups. There was no significant difference in VASlbp-24 h, VASlbp-48 h and VASlbp-72 h (P= 0.056;P= 0.813;P= 0.189, respectively) between two groups. In experimental group, VASdural (P= 0.017), ∆VAS (P= 0.001) and VASdural-24 h (P< 0.0001) were lower, whereas maternal satisfaction was higher (P= 0.046). There was no significant difference in VASdural-48 h, VASdural-72 h, urination function, strength recovery and hospitalization stay (P= 0.069;P= 0.667;P= 0.105;P= 0.133;P= 0.754, respectively) between the two groups.ConclusionsMinimally invasive spinal anesthesia provided lower VASdural, VASdrual-24 h and a higher maternal satisfaction. Hence, it is considered as a safe, reliable and reasonable option for cesarean section parturients during maternal anticoagulation therapy with normal platelet count and coagulation time.Trial registrationThis study was registered at www.ClinicalTrials.gov at November 11th, 2016 ( NCT02987192 ).