丙泊酚联合瑞芬太尼在剖宫产全身麻醉中的应用  

Application of remifentanil combined with propofol of general anesthesia for cesarean section

作　　者：屈军[1] 刘晖[1] 刘锦[1] 

机构地区：[1]广东医学院附属西乡人民医院麻醉科,广东深圳518102

出　　处：《新乡医学院学报》2011年第2期182-184,共3页Journal of Xinxiang Medical University

摘　　要：目的探讨丙泊酚联合瑞芬太尼在全身麻醉下剖宫产术中的应用价值。方法选择足月单胎剖宫产术不适宜常规椎管内麻醉的孕妇151例,分为观察组(n=76)和对照组(n=75),观察组给予异丙酚1.5 mg.kg-1、瑞芬太尼1.0μg.kg-1、阿曲库胺0.8 mg.kg-1,缓慢静脉推注,术中以瑞芬太尼和丙泊酚靶控泵入维持;对照组给予丙泊酚1.5 mg.kg-1、芬太尼1.0～2.0μg.kg-1、阿曲库胺0.8 mg.kg-1,缓慢静脉推注,术中以丙泊酚靶控泵入和间断静脉推注芬太尼维持;2组均面罩给氧3 min后气管插管,比较2组产妇术中心率和平均动脉压(MAP)的变化及2组新生儿Apgar评分。结果观察组诱导时、诱导后3 min、胎儿娩出时、胎儿娩出后5 min产妇MAP与术前比较,差别无统计学意义(P>0.05);对照组胎儿娩出时、胎儿娩出后5 min产妇MAP低于术前(P<0.05)。观察组诱导时、胎儿娩出时产妇心率较术前加快(P<0.05),诱导后3 min、胎儿娩出后5 min产妇心率与术前比较,差别无统计学意义(P>0.05);对照组诱导时、胎儿娩出时、胎儿娩出后5 min产妇心率较术前加快(P<0.05)。对照组在胎儿娩出时和胎儿娩出后5 min产妇的MAP明显低于观察组(P<0.05);对照组在诱导时、胎儿娩出时和胎儿娩出后5 min,产妇的心率明显快于观察组(P<0.05)。观察组新生儿出生5 min时Apgar评分高于对照组(P<0.05)。结论对于存在椎管内麻醉禁忌证的产妇,应用丙泊酚联合瑞芬太尼实施全身麻醉,对产妇的循环功能影响较小,同时对新生儿Apgar评分无明显影响。Objective To discuss the application of remifentanil combined with propofol of general anesthesia for cesarean section.Methods One hundred and fifty-one expectant mother with full-term single tire cesarean section not suitable for conventional spinal canal anesthesia were divided into observation group（n=76） and control group（n=75）.The observation group was given propofol 1.5 mg·kg-1,remifentanil 1.0 μg·kg-1 and atracurium amine 0.8 mg·kg-1 through intravenous injection slowly,and remifentanil and propofol were given by target-controlled infusion to maintain during the operation;The control group was given propofol 1.5 mg·kg-1,fentanyl 1.0-2.0 μg·kg-1,atracurium amine 0.8 mg·kg-1 intravenous injection slowly,and propofol was given by target-controlled infusion and fentanyl was given intermittently by intravenous injection.The two groups were given mask oxygen inhalation for three minutes,then endotracheal intubation was given for the patients.The changes of heart rate（HR） and mean arterial pressure（MAP） of expectant mother and the scores of neonatal Apgar were compared between two groups.Results Compared with the preoperative MAP,there was no statistically significant at the time of induction,after induction three minutes,the time of fetal disengagement and after fetal disengagement three minutes in observation group（P〉0.05）.In control group,the MAP at the time of fetal disengagement and after fetal disengagement five minutes was lower than that before surgery（P〈0.05）.In observation group,the HR of puerpera increased than that before surgery（P〈0.05）;Compared with the preoperative HR,there was no statistically significant at the time of induction three minutes and after fetal disengagement five minutes（P〉0.05）.In control group,the HR at the time of induction and fetal disengagement and after fetal disengagement five minutes was faster than before surgery（P〈0.05）.The MAP at the time of fetal disengagement and after fetal disengagement five minutes in control gro

关 键 词：丙泊酚 瑞芬太尼 剖宫产 全身麻醉 

分 类 号：R971[医药卫生—药品]