全身麻醉对剖宫产产妇分娩新生儿的影响  

Safety of general anesthesia on cesarean section-deliveried neonates

作　　者：李海冰[1] 周守静[2] 梁伟民[2] 王丽红[2] 刘志强[1] 

机构地区：[1]同济大学附属上海市第一妇婴保健医院麻醉科,200032 [2]复旦大学附属华山医院麻醉科

出　　处：《国际麻醉学与复苏杂志》2007年第5期399-402,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨剖宫产产妇实施全身麻醉对新生儿的影响。方法选择全身麻醉或硬膜外阻滞下行择期剖宫产产妇各30例,分别组成全身麻醉组和硬膜外阻滞组。全身麻醉组产妇先后静脉注射异丙酚2 mg/kg、琥珀胆碱1.5 mg/kg、并给予气管插管。麻醉维持:40%笑气+60%氧气+0.5MAC异氟醚,及维库溴铵0.08 mg/kg,硬膜外阻滞组产妇应用1.73%碳酸利多卡因4 ml+5 ml+5 ml(含1:200 000肾上腺素)椎管内注入。两组分别于胎儿娩出后立即抽取新生儿脐动脉血进行血气分析,并记录两组新生儿出生后1 d～5 d的新生儿神经行为评分(NBNA):新生儿行为能力、被动肌张力、主动肌张力、原始反射、一般状态。结果①血气分析:全身麻醉组新生儿pH值、二氧化碳分压(PaCO_2)、氧分压(PO_2)、动脉氧饱和度(SaO_2)及碳酸氢根(HCO_3^-)分别为7.21±0.08、(56.1±16.5)mm Hg、(23.1±11.0)mm Hg、(29.9±20.6)%、(19.1±3.4)(mmol/L)。硬膜外阻滞组新生儿分别为7.37±0.06、(51.3±9.7)mm Hg、(17.5±6.9)mm Hg、(21.8±12.7)%、(21.6±3.3)(mmol/ L)。②NBNA:全身麻醉组第1 d,2 d,3 d,5 d的NBNA分别为(36.1±2.8)、(37.0±5.1)、(38.3±2.3)、(38.7±2.3)分。硬膜外阻滞组分别为(37.2±2.5)、(38.7±1.9)、(39.1±4.5)、(39.2±5.1)分。两组各项评分比较,差异均无统计学意义(P>0.05)。结论剖宫产产妇采用常规剂量药物实施全身麻醉对新生儿安全无明显影响。Objective To study the safety of general anesthesia on cesarean section- deliveried neonates. Methods Singleton pregnant women with 37 gestation weeks were anesthetized with general anesthesia or epidural block for elective cesarean section. General anesthesia was induced with propofol （2 mg/kg） and scoline （ 1.5 mg/kg） , followed by tracheal intubation. Anesthesia was maintained with inhalation of nitrous oxide and isoflurane and intravenous infusion of vecuronium （0.08 mg/kg）. Epidural block was performed at L1,2 or L2,3 space and 1.73% lidocaine carbonate was injected epidurally. Blood gas from umbilical artery was analyzed. Neonatal behavioral neurological assessments （NBNA） of 1 to 5 post - birth days were tested. Results A little increase （ P 〉 0.05 ） in blood PaCO2 , PaO2 and SaO2 , and a significant reduction （P 〈 0.05 ） in blood pH and HCO3^- was observed in neonates deliveried under general anesthesia. However, there was no difference in NBNA scores （neonatal adaptive capacity, passive tone, active tone, primary reflexes and general status） between neonates under two anesthetic methods. Condusion The results of this study demonstrated that general anesthesia is safe for elective cesarean section - deliveried neonates.

关 键 词：剖宫产术 全身麻醉 硬膜外麻醉 新生儿 

分 类 号：R614[医药卫生—麻醉学]