30例重症甲型H1N1流感孕妇剖腹产麻醉分析  

Anesthesia analysis on cesarean section of 30 pregnant women with severe H1N1 influenza

作　　者：赵佳平[1] 胡海立[1] 侯米莎[1] 王娓 

机构地区：[1]首都医科大学附属北京地坛医院,北京100015 [2]中国水科院社区卫生服务站

出　　处：《中华实验和临床感染病杂志（电子版）》2013年第2期66-69,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的观察分析并发重症甲型H1N1流感及伴有急性呼吸窘迫综合征(ARDS)孕妇患者的麻醉方法,探讨全麻用药对其呼吸功能及新生儿Apgar评分情况的影响。方法 8例重症患者采用连续硬膜外麻醉,22例甲型H1N1流感伴ARDS患者采用全身麻醉。血浆靶控(TCI)浓度瑞芬太尼为2.0ng/ml、丙泊酚为1.5μg/ml、单次静脉注射咪达唑仑0.03～0.04mg/kg、顺式阿曲库铵0.06～0.08mg/kg麻醉诱导完成气管插管。以2.5ng/ml瑞芬太尼和3μg/ml丙泊酚血浆靶控,维持麻醉深度。比较其术前、术后血气检测结果及插管前、插管时、切皮、术中、术毕的脉搏-血氧饱和度(SPO2)情况。记录新生儿出生后1min和5min的Apgar评分。结果 30例全麻患者麻醉前、后血气检查结果差异无统计学意义(P均>0.05)。插管时、切皮、术中的脉搏-血氧饱和度(SPO2)与术前基础值相比SPO2有显著改善,差异具有统计学意义(P均=0.000);术后与术中SPO2值均低于插管时SPO2水平,但差异无统计学意义(P=0.543、0.715)。新生儿1min和5min Apgar评分无显著变化。结论麻醉方法、药物对经过术前治疗的重症甲型H1N1流感患者及伴有ARDS患者的呼吸功能、新生儿Apgar评分无显著影响。术后除2例危重症患者因原发病治疗无效死亡,余患者均痊愈出院。Objective To observe and analyze the anesthesia method of pregnant women complicated with severe H1N1 influenza and acute respiratory distress syndrome （ARDS）. To investigate the anesthesia medication on respiratory function and the effect on the Apgar score of newborns. Methods Eight patients with severe symptoms received continuous epidural anesthesia, while 22 cases with H1N1 influenza and acute respiratory distress syndrome （ARDS） received general anesthesia. Infusion of remifentanil as 2.0 ng/ml, propofol as 1.5 ug/ml, single intravenous injection of midazolam as 0.03-0.04 mg/kg, cisatracurium as 0.06-0.08 mg/kg, were maintained before tracheal intubation by plasma target. Maintenance of anesthesia depth were maintained through remifentanil 2.5 ng/ml, propofol 3 ug/ml （TCI） continuously during anesthesia. The results of the preoperative, postoperative blood gas testing and before intubation, during intubation, skin incision, during operation, after operation pulse oxygen saturation （SPO2） condition were compared. The Apgar scores of newborns after 1 and 5 minutes were recorded, respectively. Results The blood gas examination results before and after general anesthesia were not significantly different among the 30 patients （P 〉 0.05）. Compared to the situation before operation, the levels of SPO2 were significantly different in the phase of before intubation, tracheal intubation, skin incision, during operation and after operation （P = 0.000）. The level of SPO2 after operation were lower during operation and after operation compared to preoperation, but with no significant difference （P = 0.543, 0.715）. The anesthesia medication had no significant effect on Apgar scores of newborn. After treatment, two severe cases died, others were completely cured and discharged. Conclusions Anesthesia or medication had no effect on respiratory function and Apgar score in patients with severe H 1N 1 influenza A and acute respiratory distress syndrome （ARDS）.

关 键 词：甲型H1N1流感 剖腹产 麻醉 呼吸功能 APGAR评分 

分 类 号：R614[医药卫生—麻醉学]