Effect of anesthesia factor on prognosis of cesarean section in parturients with medium and severe pulmonary arterial hypertension / 中华麻醉学杂志

ABSTRACT

Objective To compare the effects of general anesthesia and spinal anesthesia on prognosis of cesarean section in parturients with medium and severe pulmonary arterial hypertension (PAH).Methods Parturients with medium and severe PAH,at ≥ 24 weeks of gestation,aged 20-45 yr,undergoing elective cesarean section under general or epidural anesthesia from November 1,2011 to December 31,2017 in our hospital,were divided into general anesthesia group and epidural anesthesia group according to the anesthetic method.General anesthesia was combined intravenous-inhalational anesthesia.The highest temperature within 5 days after surgery,the lowest SpO2 (inhaling oxygen 2-4 L/min via a nasal tube) within 3 days after surgery,duration of intensive care unit stay,time of postoperative use of antibiotics,requirement for targeted drugs for pulmonary hypertension,results of laboratory tests (blood biochemistry,coagulation function),postoperative mechanical ventilation,length of hospital stay,and hospitalization costs were recorded.The Apgar score and weight of the newborn,postoperative complications and death of the newborn and parturients in hospital were recorded.Cox regression analysis was used to identify the risk factors after cesarean section in parturients with medium and severe PAH.Results Fifty-seven parturients were enrolled in this study,with 21 cases in general anesthesia group and 36 cases in epidural anesthesia group.Compared with general anesthesia group,the rate of postoperative mechanical ventilation was significantly decreased,the incidence of adverse events of parturients in hospital and mortality rate were decreased,the postoperative level of albumin was increased,activated partial thromboplastin time was shortened (P＜0.05),and no significant change was found in the other parameters in epidural anesthesia group (P＞ 0.05).The results of Cox regression analysis showed that anesthetic method and preoperative SpO2difference were independent risk factors for cesarean section-related adverse events and death of parturients with medium and severe PAH.The risk of adverse events and death of parturients was significantly higher in general anesthesia group than in epidural anesthesia group (P＜0.05).Conclusion Epidural anesthesia produces better prognosis than general anesthesia when used for cesarean section in parturients with moderate and severe PAH.