子宫外产时术中麻醉深度的临床观察  

The Clinical Study of Anesthesia Depth in Ex-utero Intrapartum Treatment

作　　者：叶玉萍[1] 刘涌[1] 倪如飞[1] 夏媛[1] 李彩桦[1] 刘吉平[1] 

机构地区：[1]广东省佛山市妇幼保健院麻醉科,广东佛山528000

出　　处：《医学综述》2013年第7期1319-1321,共3页Medical Recapitulate

摘　　要：目的探讨子宫外产时处理(EXIT)技术适宜的麻醉深度。方法选取2010年1月至2012年12月就诊于佛山市妇幼保健院的育龄期妇女3例,择期行EXIT的孕妇以异氟烷吸入麻醉为主,分别维持麻醉深度于麻醉深度分级(NTS)的D1、E0和E2级。所有患者术前常规快速静脉诱导后气管插管行机械通气。记录3例患者诱导前(T0)、母体手术开始(T1)、取出胎儿(T2)、断脐(T3)和手术结束(T4)时的生命体征,包括平均动脉压(MAP)、心率(HR)、经皮脉搏氧饱和度(SpO2)、麻醉深度指数(NTI)及最低肺泡气有效浓度(MAC)值;3例患者术中胎儿在胎儿取出(FT0)、胎儿手术开始(FT1)、肿瘤切除(FT2)、胎儿手术结束(FT3)和断脐(FT4)时的HR、SpO2、体温(T);记录产妇苏醒时间和出血量。结果 3例患者均出现T1时的MAP降低,HR增快,E2级患者各指标均高于D1级的患者;E2级患者术后苏醒时间最长,出血量最大;D1级患者的胎儿心率在FT2、FT3时较FT0显著增加。结论 EXIT较适宜的麻醉深度为E0级,既能将深麻醉对母儿双方造成的不良影响减至最低,又不影响手术顺利进行。Objective To disscuss the suitable anesthetic depth in ex-utero intrapartum treatment （EXIT）. Methods 3 scheduled EXIT cases from Foshan Children and Maternal Hospital during Jan. 2010 and Dec. 2012 were maintained with isoflurane and the anesthetic depth NTS grading were set as D1 , E0 and E2. All the patients were given endotracheal intubation and mechanical ventilation after rapid intravenous induction. The mothers＇ vital signs including MAP, HR, SPO2 , MAC and NTI at the time point of before induction （ T0 ）, operation beginning（ T1 ）, fetus removed （ T2 ）, umbilical cord severing （ T3 ） and operation over（ T4 ） were recorded, as well as the fetus＇ HR, SPO2 and temperature when the fetus removed（ FT0 ）, fetal operation beginning（ FT1 ） ,fetus＇ tumor removed（ FT2 ） , fetal operation over（ FT3 ） and umbilical cord severing（ FT4 ）. The time of recovering and blood loss were recorded. Results Mean artery pressure of three patients decreased and HR increased at T1 ,there were significant difference between grade E2 and grade D1. The patient of stage E2 had the most long time of mother recovering and the most blood loss. The fetal heart rate increased significantly at FT2 and FT3 D1 of patient. Conclusion The suitable anesthetic depth should be grade E0 , which can lower the adverse effects of deep anesthesia on mother and child to the best without affecting the process of operation.

关 键 词：产时子宫外手术 麻醉深度 异氟烷 

分 类 号：R714.22[医药卫生—妇产科学]