脊髓麻醉与全身麻醉用于新生儿肥厚性幽门狭窄的比较：回顾性研究
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Spinal anesthesia compared with general anesthesia for
neonates with hypertrophic pyloric stenosis. A retrospective study
背景与目的
儿童脊髓麻醉的研究仅限于低风险患者群体，与大多数机构中该年龄组的全身麻醉相比，脊髓麻醉的使用仍然相对不足。根据我们的经验，在新生儿和婴儿的幽门切开术中，脊髓麻醉似乎是一种很好的替代全身麻醉的方法。本研究的目的是回顾性评估接受幽门切开术的婴儿的脊髓麻醉与全身麻醉的呼吸系统发生率。
方 法
萨拉曼卡大学医院在2003-2017年间对接受幽门切开术的婴儿使用了脊髓或全身麻醉。以呼吸暂停的发生率做为主要评估结果。第二指标是氧饱和度低于95%的发生率。对连续变量进行t检验或u-mann-whitney检验，对分类变量进行卡方检验。进行逻辑回归来解释人口统计学和临床协变量的差异。
结 果
研究样本包括68名接受幽门切开术的婴儿和新生儿(48名采用脊髓麻醉，20名采用全身麻醉)。全麻组（数量/百分比=5/20，25%）和脊麻组（数量/百分比=0/48，0%）术后呼吸暂停发生有显著差异。绝对危险度降低率为25%（95%置信区间：6%-44%），P<0.001。
结 论
在肥厚性幽门狭窄的新生儿进行幽门切开术中实施脊髓麻醉是全身麻醉的可行替代方案，可降低患儿的呼吸系统发生率。
原始文献摘要
Sánchez-Conde MP, Díaz-Alvarez A, Palomero Rodríguez MÁ, Garrido Gallego MI,Martín Rollan G, de Vicente Sánchez J, Laporta Báez Y, Vaquero Roncero LM,Rodríguez López JM. Spinal anesthesia compared with general anesthesia for neonates with hypertrophic pyloric stenosis. A retrospective study. Paediatr Anaesth. 2019 Jul 19. doi: 10.1111/ pan. 13710. [Epub ahead of print] PubMed PMID: 31322 795.
Background Studies of spinal anesthesia in children are limited to a reduced group of high-risk patients and it remains relatively underused compared with general anesthesia in this age group in most institutions. In our experience, spinal anesthesia appears to be a good alternative to general anesthesia during pyloromyotomy in neonates and infants.
Aims The purpose of this study was to retrospectively evaluate respiratory morbidity of spinal anesthesia compared to general anesthesia in infants undergoing pyloromyotomy.
METHODS The University Hospital of Salamanca used spinal or general anesthesia on infants undergoing pyloromyotomy between 2003-2017. The primary outcome assessed was the prevalence of apnea. The second one was the prevalence of oxygen saturation below 95%.An analysis was performed using t-test or U-Mann-Whitney test for continuous variables, and Chi-square for categorical variables. Logistic regression was done to account for differences in demographic and clinical covariates.
RESULTS The study sample consisted of 68 infants and neonates undergoing pyloromyotomy (48 with spinal anesthesia and 20 with general anesthesia). There was a significant difference in apneic episodes after surgery between general (number/percentage = 5/20, 25%) and spinal (number/percentage = 0/48, 0%) groups.Absolute risk reduction is 25% (CI 95%: 6%-44%), p < 0.001.
CONCLUSIONS Spinal anesthesia in neonates with hypertrophic pyloric stenosis undergoing pyloromyotomy was a viable alternative to general anesthesia, reducing the respiratory morbidity associated with the latter.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：李美胜 编辑：何幼芹 审校：王贵龙