| ObjectiveIn recent years, surgical technique of cesarean and the way of improvement, the improvement of anesthesia and monitoring greatly improved the security of the cesarean delivery, which more and more widely used in clinic. For the safety of puerpera and fetal, it is very important for women when selecting a cesarean section surgery for anesthesia choice. Combined spinal-epidural anesthesia (CSEA) through cerebrospinal fluid direct effects on spinal nerve root, so more quickly, muscle relaxant effect,analgesic effect and Analgesic effect is good, which is almost no affect on hemodynamics, have a significantly lower incidence of maternal pull, adverse reaction in patients with significantly reduced under the premise of control well of the anesthetic drug,for CSEA;and can be used for postoperative analgesia.A few reports nerve injury that CSEA have been cause, CSEA cause nerve injury reports more than other patients on obstetric patients of cesarean section, but the reason it is not clear so far. The existing literature at home and abroad on the reported the incidence of nerve injury is differ, actual nerve injury may be more than the existing various kinds of literature reports. Therefore, it should be anesthesia community attaches great attention for nerve injury. But it research in China and abroad compared with research, observation of the number of cases, observe the hospital level, less lack of scientific clinical epidemiological survey and analysis method; And greatly influenced by operation level and equipment operation, which research focus on anesthesia and local anesthesitics, but a few the correlative factor of obstetric; Therefore it is very necessary that we research it. The research puerpera cesarean section under CSEA was investigation and study in hospital of Tanbai County of Zhongshan city during June 2013 to December 2014, in order to understand our hospital the incidence of nerve injury puerperal cesarean section undergoing CSEA,and analyze the severity, duration,rehabilitation, and analyze the correlation obstetric factors and other factors,which provide clinical reference for prevent and treatment.Material and MethodMaterialTo foresight study was nerve injury for 1382 cases of puerperas cesarean section undergoing CSEA in hospital of Tanbei County of Zhongshan city during June 2013 to December 2014.CSEA MethodPreoperative fasting regularity, and intravenous access was established in operation room, monitoring non-invasive blood pressure, heart rate, respiration and pulse oxygen saturation, nasal catheter in the flow of oxygen,130/0.4 hydroxyethyl starch and sodium chloride quickly injection; Cesarean section:CSEA puncture the conventional method. Taking the lateral position, L3-4 puncture,0.5% bupivacaine 8-10mg subarachnoid injection 30-40s if cerebrospinal fluid was unobstructed.,take the epidural catheter(deep 3-4cm), you need to confirm the position of puncture needle. When Anesthesia operation appear abnormal sensorium change epidural analgesia s to intravenous analgesia and removed epidural cathers. Levels of anesthesia has been control under the sensory block to T6. Intraoperative give 3～5 ml of 2% lidocaine test dose, observe 5～10min, Confirmed epidural catheter into blood vessels and the subarachnoid space. Poor intraoperative anesthetic effect can not meet the requirement of the operation, when the epidural space continuous additional 2% lidocaine to finish. Intraoperative maintain stable vital signs, slow intravenoused injection methoxamine 2mg when patients blood pressure lower 20% above the base value, atropine 0.5 mg have been intravenoued injection when heart rate less than 55/minutes, raises the open airway or oxygen mask when SPO2 has lower than the 92% increase the oxygen flow rate.Methods of StudyForm included general materials(including age, height, weight, gestational age, CSEA time, Local anesthesia, and so on) and obstetric correlation information (fetal times, gestational diabetes, pregnancy-induced Hypertension syndrome, cicatricial uterus, abnormal labor, fetal distress, cephalopelvic disproportion, fetal macrosomia high character, macrosomia, abnormal birth canal, horse hooves, etc.). Statistical nerve injury, nerve injury symptoms (including obstacle of feeling, pain,decreased muscle strength and other major symptoms) of puerpera, record postoperative 1,2,3,4,5,7,10,14,30 and 60 day sensory disorder (including allergic, decrease and loss, and feeling perversion) parts; Pain and nature; muscular tension (muscle is divided into six levels, level 0 is completely paralyzed, level 5 is normal) loss and other complications. if maternal did not completed relieve nerve injury symptoms when discharge from hospital, complete the research data by telephone or treatment nerve injury in out patient department.Treatment of nerve injuryPostoperative visit found puerperas the nerve injury symptoms immediately removed epidural catheters, change to intravenous analgesia, ensure that the analgesic effect of maternal; and intravenous dexamethasone 10 mg,1 times/day,1 days before symptoms get better, continue to mannitol 125 ml intravenous drip,2 times/day, oral vitamin B complex,2 days later without significantly improved in physical therapy, massage and hot compress, cooperate to strengthen the comprehensive treatment such as functional exercise again, and relieve tension, anxiety and other negative maternal psychological mood of puerperas; If nerve injury symptoms were still not completely discharged recovery, continue to give the same comprehensive treatment in outpatient service until the nerve injury symptoms completely recovered.Statistical analysisAll data was analyzed by SPSS14.0 statistical software,and it used descriptive analysis,χ2 test and Fisher’s exact method, The multifactorial risk indexes were obtained by stepwise logistic regression analysis. Research factors including (fetal times, gestational diabetes, pregnancy-induced Hypertension syndrome, cicatricial uterus, labnormal labor, fetal distress, cephalopelvic disproportion, fetal macrosomia high character, macrosomia,breech position and double fetals) The puerperas were analyzed for events before and after operation. P<0.05 considered statistically difference.Result1. General informationTo foresight study was nerve injury for 1382 cases of puerperas cesarean section undergoing CSEA in hospital of Tanbei County of Zhongshan City during June 2013 to December 2014.2. Cesarean section indicationsThe survey research; Primary cesarean section indications of scar uterus of 259 cases (18.74%), abnormal labor of 211 cases (15.26%),202 cases of fetal distress (14.61%),125 case of cephalopelvic disproportion (9.04%), Pregnancy Induced Hypertension says was 98 cases, accounting for 7.09%; others says 487 cases, accounting for 35.23%.3 Compare with general information two groupsThe incidence of nerve injury of general materials (including age, height, weight, gestational age,CSEA time, and local anesthetics)were compared,the difference was not statistically significant (P>0.05)4.The analysis correlation factors nerve injuryLogistic regression analysis showed that puerperas "anomalous labor" have correlation with CSEA after nerve injury.211 cases of abnormal maternal labor undergoing CSEA in cesarean section with 16 cases of the nerve injury symptoms, the incidence of nerve injury was 7.58%, anomalous labor is a risk factor for nerve injury, (OR) of 6.12895% CI 2.168～17.321, and P< 0.05, the difference was statistically significant.5.The incidence of nerve injury5.1 The total incidence of nerve injuryThe survey of 1382 cases of puerperas scesarean section undergoing CSEA, a total of 62 cases of nerve injuries, the The total incidence of of 4.48%,it less than others.5.2 Different incidence of cesarean section indications maternal nerve injuryIn the main indications of cesarean section a few; 211 cases of 16 cases of abnormal maternal labor CSEA nerve injury symptoms, the incidence of nerve injury was 7.58%, the highest incidence of nerve injury; Secondly for cephalopelvic disproportion,125 cases of maternal 7 cases of nerve injury symptoms, the incidence is 5.60%; Again is scar uterus was 4.63%,98 cases of pregnancy Induced Hypertension appear 4 cases of nerve injury symptoms, the incidence was 4.08%, the incidence of nerve injury minimum for the fetal distress was 3.96%.6. The incidence of nerve injury comparison between different groups6.1 compared with abnormal labor group and none the abnormal labor groupAbnormal maternal labor group injury incidence was 7.58%, than the 3.92% significantly higher incidence of none abnormal labor group of nerve injury, squared = 5.48 (P=0.001, P< 0.05), with statistical significance.6.2 compared with between different groupsThere were no statistically significant difference in these groups of (scar uterus and none the scar uterus, fetal distress and none fetal distress, cephalopelvic disproportion and cephalopelvic disproportion, pregnancy-induced hypertension and none pregnancy-induced hypertension), (P>0.05), other factors did not increase nerve injury.7 The rehabilitation of nerve injury1382 cases of puerperas, that nerve injury was 62 cases, the incidence of nerve injury of 4.48%,43 cases of puerperas rehabilited within 5 days, the incidence of 3.11%,they were belong to the Transient Neurological Syndrome; 19 cases belong to delayed feeling obstacle, the incidence was 1.37%, of which 15 patients discharged when there are still some paresthesia, which recoveryied 10 days; 3 patients will still be hypoesthesia after discharge, but recovered after one month and 1 case of 2 months back, did not appear the cauda equina syndrome, all maternal nerve injury symptoms completely recover, not present any sequelae.Conclusion1. The total incidence of nerve injury of maternal cesarean section undergoing CSEA was 4.48%.2 The abnormal labor is a risk factor for nerve injury,The incidence of nerve injury abnormal labor undergoing cesarean section was 7.58%,more than the 4.09% incidence of none abnormal labor group, other obstetric factors did not statistically significant.3. It appear only TNS and delayed sensory disturbance,but no cauda equina syndrome. |
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