妊高症血小板减少患者剖宫产，你的麻醉选择是？

本文由“小麻哥的日常"授权转载

摘要译文（供参考）

妊娠期高血压疾病中血小板减少症剖宫产的全身麻醉：来自产科气道管理登记的结果

背景： 在资源有限的环境中，腰麻（SA）是剖宫产的首选。 对于有脊髓硬膜外血肿风险的女性，尤其是患有妊娠期高血压疾病的女性，在神经轴阻滞前应排除血小板减少症。 在胎儿窘迫的紧急手术中，由于实验室检查不可用或不在现场，这项调查可能会受到阻碍。

方法： 产科气道管理登记处（ObAMR）目前活跃于开普敦大学附属的所有麻醉培训机构。 这项多中心观察性研究旨在估计因确诊或疑似血小板减少症而接受全身麻醉（GA）的患者比例，但由于实验室结果不可用，血小板减少并未被排除在外。 为了确定在血小板计数可用的情况下可以避免使用GA的数量，我们回顾性搜索了怀疑血小板减少症患者的后续血小板计数。提出了一种算法，包括一个简单的决策辅助工具，用于评估SA与GA的风险与收益，在妊娠期高血压疾病和血小板减少症的情况下遵循该算法。

结果： 在登记的591名患者中，100名患者（16.9%）的血小板减少是GA的适应症。总共591人中有48人（8.1%）确诊血小板减少症，591人（8.8%）中有52人怀疑血小板减少症。 在这些患者中，91名患者患有妊娠期高血压疾病。

在确诊的血小板减少组中，GA的适应症是血小板计数<75×109/L。 在疑似血小板减少症组中，52例（88.5%）血小板计数中有46例可追溯。 血小板计数中位数（四分位间距）为178×109/L（93-233×109/L），46例患者中有41例（89.1%）血小板计数超过75×109/L，1例伴有先兆子痫的血小板减少症。

结论： 在17%的患者中，GA的适应症是血小板减少。因为手术时血小板计数不可用，100人中有52人（占591人总数的近9%）接受了GA。应强调早期实验室评估的重要性。总的来说，591人中有41人（6.9%）的血小板计数大于75×109/L，如果他们的血小板计数已知，就不需要GA。在遵循构建的算法并应用决策辅助来评估风险和收益后，当血小板计数显示但不可用时，可能会出现临床医生合理选择SA的情况。

原文摘要 General Anesthesia for Cesarean Delivery for Thrombocytopenia in Hypertensive Disorders of Pregnancy: Findings From the Obstetric Airway Management Registry Background: In resource-limited environments, spinal anesthesia (SA) is preferred for cesarean delivery. In women at risk of spinal epidural hematoma, particularly those with hypertensive disorders of pregnancy, thrombocytopenia should be excluded before neuraxial blockade. In the context of emergency surgery for fetal distress, this investigation may be hampered by laboratory services being unavailable or off-site. Methods: The Obstetric Airway Management Registry (ObAMR) is currently active across all anesthesia training institutions affiliated with the University of Cape Town. This multicenter observational study aimed to estimate the proportion of patients receiving general anesthesia (GA) for either confirmed or suspected thrombocytopenia, which was not excluded due to unavailability of laboratory results. To establish the number of GA uses that may have been avoided if platelet counts were available, we retrospectively searched for subsequent platelet counts in patients for whom thrombocytopenia was suspected. An algorithm was proposed, including a simple decision aid for estimating risk versus benefit of SA versus GA, to be followed in the setting of hypertensive disorders of pregnancy and thrombocytopenia. Results: Thrombocytopenia was the indication for GA in 100 of 591 patients (16.9%) captured in the registry. In total, 48 of 591 (8.1%) had confirmed thrombocytopenia, and 52 of 591 (8.8%) had suspected thrombocytopenia. Of these patients, 91 of 100 had a hypertensive disorder of pregnancy. In the confirmed thrombocytopenia group, the indication for GA was a platelet count <75 × 109/L. In the suspected thrombocytopenia group, 46 of 52 (88.5%) platelet counts could be retrospectively traced. The median (interquartile range) platelet count was 178 × 109/L (93 - 233 × 109/L), and platelets exceeded 75 × 109/L in 41 of 46 patients (89.1%). In the 5 of 46 patients with retrospectively confirmed thrombocytopenia, 2 had hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, 2 had antepartum hemorrhage with preeclampsia, and 1 had isolated thrombocytopenia with preeclampsia. Conclusions: In 17% of patients, the indication for GA was thrombocytopenia. Of these, 52 of 100, or nearly 9% of the total of 591, received GA because a platelet count was unavailable at the time of surgery. The importance of early laboratory assessment, when available, should be emphasized. Overall, 41 of 591 (6.9%) had a platelet count >75 × 109/L and would not have needed GA if their platelet count had been known. After following the constructed algorithm and applying the decision aid to assess risk and benefit, there may be circumstances in which the clinician justifiably opts for SA when a platelet count is indicated but unavailable.

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编辑：Michel.米萱

校对：Mijohn.米江

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