丙泊酚诱导全麻剖宫产时血药浓度测定及其对新生儿Apgar评分和神经行为能力的影响  

Effects of general anesthesia induced by disopropofol for cesarean section on Apgar scores and NBNA of fetuses.

作　　者：冯颢[1] 金延武[2] 王端玉[3] 冯昌[2] 丁华[1] 

机构地区：[1]山东大学医学院药理学研究所,济南250012 [2]山东大学第二医院麻醉科 [3]山东大学医学院

出　　处：《现代妇产科进展》2008年第9期680-682,共3页Progress in Obstetrics and Gynecology

摘　　要：目的:测定丙泊酚诱导全麻剖宫产时产妇静脉血和新生儿脐血中的药物浓度,观察它的麻醉效应和对新生儿Apgar评分及神经行为能力(NBNA)的影响。方法:因特殊情况不宜行硬膜外麻醉剖宫产的足月孕妇30例,用丙泊酚2mg/kg诱导联合琥珀胆碱辅助肌松行全身麻醉剖宫产术(A组),于新生儿娩出时、脐带结扎后分别抽取胎盘侧脐带中脐静脉、脐动脉和母体外周静脉血各5ml,用HPLC-荧光检测法测定血中丙泊酚的浓度,记录产妇术前、意识消失、手术开始、胎儿娩出、手术结束和意识恢复时的脑电双频谱指数(BIS)。另随机选择30例常规硬膜外麻醉剖宫产孕妇(B组),记录并比较两组新生儿娩出后1、5min时的Apgar评分以及新生儿出生后3天和10天的NBNA分值。结果:丙泊酚在母体静脉血中的药物浓度为2.26±0.71μg/ml,在正常麻醉范围内。脐静脉血药浓度为0.83±0.25μg/ml,脐动脉血药浓度为0.78±0.24μg/ml,均低于苏醒浓度。术中产妇生命体征平稳,无意识恢复,术后随访无术中知晓发生。全麻组和硬膜外麻醉组新生儿Apgar评分及NBNA评分均无显著差异(P>0.05)。结论:丙泊酚2mg/kg诱导全麻剖宫产术对新生儿Apgar评分及NBNA评分无明显影响,产妇处于镇静状态。Objective：To observe the blood concentration of puerperas and fetuses in general anesthesia induced by disopropofol for Cesarean section and to determine the effects on puerperas and fetuses. Method：Thirty pregnant women took Cesarean section under general anesthesia induced by 2mg/kg disopropofol and celocaine with monitoring ECG, HR, SpO2, MAP. Blood samples withdrawn from MV, UV, UA before ligature of the cord were studied by HPLC. The BIS scores of the puerperas were recorded during the whole operation. The Apgar scores in lmin and 5min and NBNA scores in 3d and 10d of fetuses after expulsion were recorded and compared with those took Cesarean section by epidural anesthesia. Result：The blood concentration of disopropofol in MV was 2.26 ±0.71μg/ml,0.83 ±0.25μg/ml and 0.78 ±0. 24μg/ml in UV and UA respectively. No significant difference was seen between the two groups in Apgar and NBNA scores of newborn infants （ P 〉 0.05 ）. There was no intraoperative awareness according to the follow-up visit. Conclusion： Cesarean section under general anesthesia induced by 2mg/kg disopropofol and 2mg/kg celocaine has no significant effect on Apgar and NBNA scores of the fetus, it can also provide sedation to the puerperal.

关 键 词：丙泊酚 麻醉 全身 剖宫产术 血药浓度 APGAR评分 神经行为能力 

分 类 号：R614.2[医药卫生—麻醉学]