剖宫产术中异丙酚对新生儿的影响及其胎盘转移  

Placental transfer and neonatal effects of propofol for cesarean section

作　　者：冯颢[1] 金延武[1] 韩乐强[1] 孙德清[2] 冯昌[1] 刘卫廷[1] 李克忠[1] 

机构地区：[1]山东大学第二医院麻醉科,济南市250033 [2]山东大学第二医院药剂科,济南市250033

出　　处：《中华麻醉学杂志》2009年第9期811-813,共3页Chinese Journal of Anesthesiology

摘　　要：目的探讨剖宫产术中异丙酚对新生儿的影响及其胎盘转移情况。方法拟行剖宫产术的足月初产妇60例，ASA I或Ⅱ级，年龄23～31岁，体重59～89妇，身高156～169cm，随机分为2组（n=30）：全麻组（G组）和硬膜外麻醉组（E组）。G组静脉注射异丙酚2mg／kg和琥珀胆碱2mg／kg快速诱导气管插管，行机械通气，局麻辅助下开始手术。胎儿娩出结扎脐带后立即抽取脐静脉（UV）、脐动脉（UA）血样各5ml，经足背动脉取母体动脉（MA）血样5ml，采用高效液相色谱法测定血浆异丙酚浓度（CUV、CUA和Cma）；E组经L1,2行硬膜外麻醉，给予2％利多卡因11～17ml，控制感觉阻滞平面上界为T6-8。于入室5min（T0）、切皮即刻（T1）、新生儿娩出（T2）和手术结束（T3）时记录心率（HR）、脉搏血氧饱和度（SpO2）和平均动脉压（MAP）；记录分娩时间和给药结束到钳夹脐动脉、静脉的时间；胎儿娩出后1、5min时行Apgar评分。结果G组给药结束到钳夹脐动、静脉的时间短于E组（P〈0．05），两组新生儿Apgar评分、各时点HR、SpO2和MAP比较差异无统计学意义（P〉0.05），两组均未见新生儿呼吸抑制发生，G组术后随访均未发生术中知晓。CMA、CUV和CUA分别为（1．4±0．4）、（0．86±0．25）、（0．70±0．22）μg／ml，CUV／CMA和CUA／CUV分别为0．61±0．11和0．80±0．10。结论静脉注射异丙酚2mg／kg用于剖宫产术麻醉效果满意，虽然易通过胎盘，且在胎儿体内代谢慢，但并未对新生儿产生不良影响。Objective To investigate the placental transfer and neonatal effects of propofol for cesarean section. Methods Sixty ASA I or II parturients at full term, aged 23-31 yr, weighing 59-98 kg, height 156- 169 cm, undergoing elective cesarean section under general anesthesia, were randomly divided into 2 groups （ n = 30 each）： general anesthesia group （group G） and epidural anesthesia group （group E）. Group G received iv injection of propofol 2 mg/kg and suecinylcholine 2 mg/kg to facilitate tracheal intubation. Blood samples of 5 ml were drawn from umbilical vein （UV） and artery （UA）, and maternal artery （MA） after ligation of the umbilical cords respectively for determination of plasma propofol concentrations （ CUV, CUA and CMA ） by HPLC. Epidural anesthesia was performed at L1.2 interspace, 2% lidocaine 11-17 ml was administered and the upper spread of sensory block reached T6-8 . HR, SpO2 and MAP were recorded after the parturients had settled down for 5 min in the operating room （T0）, at skin incision （T1）, after delivery of the baby （T2）, and at the end of operation （T3 ） in both groups. The delivery time （duration between uterus incision and delivery of the baby）, duration between the end of administration and clamping of UA and UV, and Apgar score at 1 and 5 min after delivery were also recorded. Results The duration between the end of administration and clamping of UA and UV was significantly shorter in group G than in group E （ P 〈 0.05）, while no significant differences were found in Apgar score and HR, SpO2 and MAP at each time point between the two groups （ P 〉 0.05）. No neonatal respiratory depression in both groups and no intraoperative awareness in group G occurred. The plasma concentrations of propofol were （1.4± 0.4）, （0.86± 0.25） and （0.70 ± 0.22） μg/ml in maternal arterial, and umbilical venous and arterial blood samples respectively. Cur/CMA and CUA/CUV were 0.61 ± 0.11 and 0.80 ± 0.10 respectively. Conclusion The anes

关 键 词：二异丙酚 剖宫产术 婴儿 新生 胎盘 

分 类 号：R614[医药卫生—麻醉学]