The Analysis On The Incidence Of Neurological Complications In Maternity Patients Undergoing Neuraxial Blockade

ObjectiveNeuraxial blockade is often used in clinical anesthesia, to keep the anesthesia stable, postoperative analgesia easy.As the living standards and the technical level of perinatal medicine are improved, pregnant women put forward higher requirements for childbirth. In addition to ensure mother and fetus safety,it become the focus of obstetric anesthesia for diminishing pain during and after birth.Therefore,it is increasingly applied for labor analgesia and cesarean section, the corresponding ratio of neuraxial blockade are increased year by year.In recent years,there are some reports that neuraxial blockade cause neurologic complications.But the incidence of neurologic complications is different in the literature,especially in obstetric anesthesia.Its causes are complex, and the mechanism of neurologic complications is not clear. In clinical, anesthesiologists have not yet attracted enough attention on the risk of neurologic complications.Neurologic complications may actually occur more than expected.Neurologic complications of pregnant women are still the problem after neuraxial blockade which anesthesiologists need to pay attention to.Although there are reports of foreign,it is still a lack of large samples about neurologic complications of pregnant women related to conducting a multicenter clinical trial after neuraxial blockade.Therefore,it is necessary to establish neurological complications of obstetric anesthesia database tostatistical analysis.Hence,from May1,2012to February28,2014,a retrospective analysis of neurological complications in pregnant women undergoing neuraxial blockade were carried out in ZhuJiang Hospital of Southern Medical university in Guangzhou.To investigate and analysis the usage of neuraxial blockade in pregnant women at hospital and calculate the incidence,severity,duration and related factors of neurological injury in pregnant women,and analysis rehabilitation time, its incidence of rehabilitation in neurological complications. To investigate the incidence and factors related of neurological complications in women undergoing obstetric operation and analyze the severity,duration,rehabilitation time,its incidence of rehabilitation and related factors of neurological complications in pregnant women.To investigate the factors related of neurological complications in women undergoing neuraxial blockade and analyze the causes of neurological complications to provide reference for prevention and therapy of neurological complications.To accumulate the clinical experience of neurological complications in pregnant and epidemiology data of neurological complications after neuraxial blockade.Material and MethodMaterialA retrospective study was carried out from May1,2012to February28,2014,To aim at neurological complications of neuraxial blockade in maternity patients in ZhuJiang Hospital of Southern Medical university.The maternity patients mean no neurodegenerative disease and no mental illness history.The research objects are the maternity patients undergoing neuraxial blockade.The method of survey is post-surgery follow-up.The preliminary analysis on the usage of neuraxial blockade in maternity patients and the incidence and rehabilitation rates of neurological complications in maternity patients in ZhuJiang Hospital of Southern Medical university.Anesthesia MethodPreoperative fasting time was8hours,and intravenous access was established in operation room, monitoring non-invasive blood pressure, heart rate, respiration and pulse oxygen saturation. Cesarean section: combined spinal epidural puncture kits (Zhejiang Fert Medical Device Co., Ltd.) the conventional method. Taking the lateral position, L2-3and L3-4puncture,1%ropivacaine (batch number: NACC, AstraZeneca AB, Sweden)20mg+10%glucose2ml, with a rate of2.5-3ml subarachnoid injection of about0.2ml/s if cerebrospinal fluid was unobstructed.With advancement of the epidural catheter(3-4cm), you need to confirm the position of puncture needle.To begin operation after the sensory block to T6. Painless childbirth:Labor analgesia began after the cervix was already dilated2-3centimeters.Recipe: Sufentanil40-45ug+1%ropivacaine60mg plus saline to60ml,6-8ml/h,block level was maximum sensory block level of T10.Natural childbirth was the position of lithotomy position.Methods of InvestigationForm1included general materials(including name, age, height, weight, gestational age, previous medical history, preoperative diagnosis, maternal status and so on)among maternity patients undergoing neuraxial blockade(epidural anesthesia, spinal anesthesia and combined spinal-epidural anesthesia)、date of operation, anesthesia, time of anesthesia and operation,emergency degree,anesthesia puncture site,paresthesia,the usage of anesthesia drug,the usage of postoperative analgesic,analgesic drug,time of nerve block,neonatal weight.When pregnant women might have neurological complications,you need to finish form2.It includes recording the course of neurological complications.To supplement form2by phone or E-mail if they weren’t complete.Treatment of Neurological complicationsThere were112cases of maternity patients with symptoms of neurological complications.If the maternity patients may have neurological complications,the epidural catheters need to be removed.At the same time,10mg dexamethasone intravenous injection for2-3days,vitamin B,physical therapy,acupuncture and Chinese medicine treatment, coupled with psychological counseling to alleviate the tension and fear of maternity patients. Statistical AnalysisAll data was analyzed by SPSS13.0statistical software,and it used descriptive analysis,χ2test and Fisher’s exact method,based on the demographic and clinical characteristics to calculate the incidence and recovery rates of pregnant women undergoing neuraxial blockade.The pregnant women were analyzed for events before and after operation.The multifactorial risk indexes were obtained by stepwise logistic regression analysis.P<0.05considered statistically difference.Result1. General informationForm May2012to February2014, there are a total of2164maternity patients in ZhuJiang Hospital of Southern Medical university.There are1540maternity patients undergoing neuraxial blockade. The incidence of neurological complications with cesarean section was more than that of painless labor and natural childbirth,χ2=20.7,P<0.05,the difference was statistically significant.2.The incidence of neurological complications in maternity patients2.1The total incidence of neurological complicationsA total of112maternity patients with neuraxial blockade who underwent cesarean section or painless labor were recorded with neurological complications.The total incidence of neurological complications was7.3%.2.2Compare the general information in two groupsThe incidence of neurological complications of general materials (including age, height, weight, gestational age,nerve block time, and birth weight) in neurological complications group and the group without neurological complications were compared,the difference was not statistically significant (P>0.05)2.3Compare the incidence of neurological complications in two groupsThe incidence of paresthesia was7.0%.The incidence of neurological complications with paresthesia was more than that without paresthesia,the odds ratio (OR) was5.383and the relative risk (RR) was3.913. There are statistically significant difference between the incidence of neurological complications of the two groups (P<0.05)2.4Compare the incidence of neurological complicationsThe incidence of neurological complications in maternity patients with mild edema, moderate edema and without edema were2.2%,8.3%and10.1%, The incidence of neurological complications was the least in pregnancy with mild edema, and the incidence of neurological complications was the most in pregnancy without edema. The difference was statistically significant (P<0.05)3.The analysis related factors on neurological complicationsLogistic regression analysis showed that the paresthesia and mild edema had great correlation with neurological complications in women undergoing neuraxial blockade. There are1540maternity patients undergoing neuraxial blockade.A total of108maternity patientsn who underwent cesarean section or painless labor were recorded with paresthesia.The incidence of paresthesia was7.0%. the OR was15.020(95%confidence interval.3.174-70.955),the difference was statistically significant (P<0.05) There are608cases of tissue edema of pregnancy, including536cases of mild edema,its OR was0.268(95%confidence interval:0.155-0.441),the difference was statistically significant (P<0.05)4.The situation of neurological complicationsIn156cases of maternity patients with neurological complications, symptoms of44cases subsided after pulling out the patient controlled epidural anesthesia (PCEA). The use of PCEA after cesarean section is associated with neurological complications. Neurological complications of68cases is associated with puncture and catheterization.44cases are of unknown cause, which discharged when42cases are still sensory disturbances, and2cases of a3month follow-up showed no rehabilitation.Conclusion1.There is the most commonly used in maternity patients undergoing cesarean section, followed by natural childbirth. Painless labor is used the least. Delivery status is the high rate of cesarean section and low labor analgesia rate. The incidence of neurological complications with cesarean section was more than that with painless labor.2.The total incidence of neurological complications in maternity patients undergoing neuraxial blockade was7.3%. The incidence of neurological complications of general materials (including age, height, weight, gestational age, nerve block time, and birth weight)in neurological complications group and the group without neurological complications were compared,the difference was not statistically significant. The incidence of neurological complications of pregnancy with mild edema, moderate edema and without edema were2.2%,8.3%and10.1%. The incidence of neurological complications was the least in pregnancy with mild edema,and the incidence of neurological complications was the most in pregnancy without edema.3.The incidence of paresthesia was7.0%. Paresthesia was a risk factor for neurological complications. The incidence of neurological complications with paresthesia was more than that without paresthesia. The difference was statistically significant (P<0.05). The maternity patients of mild edema in pregnancy is a protect factor to decrease the incidence of neurological complications with neuraxial blockade.4.The incidence of rehabilitation in maternity patients with neurological complications was71.8%within five days, The incidence of that was98.7%within ten days. The maternity patients of neurological complications was not recovered by1.3%within ten days.