剖宫产术前使用咪达唑仑对胎儿的影响  

The influence of midazolam on the fetus before cesarean section.

作　　者：何志毅[1] 谭菁瑜[1] 胡淑君[1] 董庆龙[1] 欧阳葆怡[1] 

机构地区：[1]广州医学院第一附属医院妇产科麻醉科,广州510120

出　　处：《中国优生与遗传杂志》2008年第7期59-61,共3页Chinese Journal of Birth Health & Heredity

摘　　要：目的研究剖宫产术前使用咪达唑仑对胎儿的影响。方法72例择期剖宫产术孕妇随机分成4组,Ⅰ、Ⅱ和Ⅲ组麻醉前30min分别肌注咪达唑仑0.05 mg/kg、0.06 mg/kg和0.07 mg/kg,Ⅳ组为生理盐水,同时肌肉注射阿托品0.01mg/kg。于注药前和注药后30min进行焦虑视觉类比试验（AVAT）和状态焦虑问卷（SAI）测试及Ramsay镇静水平评估。连续监测孕妇的HR、RR、SpO2、MAP及胎儿胎心监护,记录注药前、注药后15min和30min测定值。胎心监护进行胎心监护异常图形分析、比较。胎儿娩出时行脐动脉血气分析、新生儿1min和5min的Apgar评分。结果注药后30min时,Ⅰ-Ⅲ组孕妇AVAT分别下降36.4%、43.2%和43.1%,SAI分别下降20.9%、24.8%和26.9%,均获得RamsayⅡ-Ⅳ级镇静水平。Ⅰ-Ⅲ组注药后30min胎心监护图形有异常改变,异常图形为基线变异减弱、心动过速、心动过缓,变化减速。5min的Apgar评分和脐动脉血气分析4组间比较无统计学差异（P〉0.05）。结论剖宫产手术前给予咪达唑仑0.05 mg/kg,对孕妇有良好的镇静和抗焦虑作用,对生命体征无明显影响。对胎儿的呼吸和循环功能影响轻微。Objective： To study the influence of using Midazolam on the fetus before Cesarean section. Methods： 72 pregnant women with elective Cesarean section were randomly divided into four groups, for Ⅰ, Ⅱ and Ⅲ groups, 0. 05 mg / kg, 0. 06 mg / kg and 0. 07 mg / kg of midazolam were intramuscularly injected respectively 30 minutes before anesthesia. The physiological saline was given for IVgroup, at the same time; atropine with 0. 01 mg / kg was given through intramuscular injection. The anxiety visual analog test （AVAT）, state -trait anxiety inventory （SAI） and Ramsay sedation level assessment were performed 30 minutes before and after injecting the drug. HR, RR, SpO2, MAP from the pregnant women and the fetal heart rate were monitored continuously and recorded the measured value 15 minutes and 30 minutes before and after injection. On fetal heart rate monitoring, the abnormal fetal heart rate monitoring waveform were analyzed and compared. The blood gas analysis for umbilical artery and 1 minute and 5 minutes Apgar score for neonate were performed on giving birth to the fetus. Results： 30 minutes after injecting the drug, AVAT of pregnant women from Ⅰ to Ⅲ groups were decreased 36. 4%, 43.2% and 43.1% respectively, SAI were decreased 20. 9%, 24. 8% and 26. 9% respectively, all had got Ramsay Ⅱ to Ⅳ - degree sedative level. 30 minutes after injection, there ware abnormal changes for the fetal heart rate monitoring waveform from groups Ⅰ to Ⅲ. The abnormal waveforms were the weakened baseline variation, tachycardia, bradycardia and changes slowdown. There ware no statistical difference （ P 〉 0. 05 ） on comparing Apgar scores on 5 minutes and the umbilical arterial blood gas analysis among four groups. Conclusion ： Giving midazolam 0. 05 mg / kg before cesarean section can produce a good sedative and anxiolytic effects on pregnant women, also, it had no obvious impact on the vital signs. At the same time, it has slight influence on the fetal respiratory and circulatory function.

关 键 词：麻醉前用药 咪达唑仑 剖宫产 

分 类 号：R614[医药卫生—麻醉学]