不同比重腰麻用于剖宫产手术对母体循环及新生儿动脉血气的影响  

The effect of different proportion of spinal anesthesia for cesarean section on maternal circulation and neonatal arterial blood gas

作　　者：李敬娴 姜鹤[2] 刘文勋[2] 叶青山[2] 

机构地区：[1]第四军医大学第一附属医院儿科,西安710032 [2]宁夏回族自治区人民医院麻醉科,银川750011

出　　处：《中华临床医师杂志（电子版）》2015年第9期76-79,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的观察、比较不同比重腰麻对产妇血压及新生儿动脉血气影响的差异,探讨对产妇、新生儿更为安全的麻醉方式。方法将60例足月妊娠拟行剖宫产术的产妇随机分为三组,每组20例,A组重比重组(蛛网膜下腔给予布比卡因15 mg+10%葡萄糖注射液1 ml),B组等比重脑脊液组(蛛网膜下腔给予布比卡因15 mg+脑脊液1 ml)、C组等比重芬太尼组(蛛网膜下腔给予布比卡因15 mg+芬太尼50μg),监测各组麻醉阻滞平面以及麻醉成功后各时间点的产妇血压、脐动脉血气及Apgar评分及不良反应,比较三组间麻醉效果及对产妇及新生儿的影响。结果麻醉完成1 min时,A组SBP低于B组(P=0.001);麻醉完成3 min时,A组DBP低于B、C组(P值分别为0.001、0.014),而HR高于B、C组(P值分别为0.027、0.012);麻醉完成5 min时,A组SBP低于B、C组(P值分别为0.001、0.014);麻醉完成10 min时,A组DBP低于B、C组(P值分别为0.000、0.043)。A组麻醉起效时间和麻醉维持时间均明显短于B、C组(均P<0.01)。三组间新生儿脐血动脉血气及1、5 min Apgar评分无统计学意义(P>0.05)。A组使用去氧肾上腺素的剂量高于B、C组(均P=0.001)。C组瘙痒发生率显著高于A、B组(均P=0.001)。结论单次细针重比重腰麻与等比重腰麻均为适合剖宫产手术的麻醉方式。但等比重腰麻起效快,麻醉效果完善,产妇血压波动小;等比重腰麻复合芬太尼50μg对新生儿血气、Apgar评分无不良影响。Objective To observe and compare the different proportion of spinal anesthesia on maternal blood pressure and arterial blood gas of neonates. To discuss the maternal and neonatal more safe anesthesia. Methods 60 cases of full-term pregnancy undergoing cesarean section were randomly divided into 3 groups, each group were 20 cases, group A was hyperbaric （injected into bupivacaine 15 mg with 10%GS 1 ml）, group B was proportion of CSF （Bbupivacaine 15 mg with cerebrospinal fluid 1 ml）, group C was proportion with fentanyl （bupivacaine 15 mg with fentanyl 50 μg）. Monitored maternal blood pressure at different time points of anesthesia, then monitored umbilical arterial blood gas, Apgar score and adverse reaction compared three groups of different proportion of spinal anesthesia and its influence on mothers and newborns. Results T1 （anesthesia completed for 1 minute） systolic blood pressure of group B was higher than A and C group （P=0.001）. T3 （anesthesia completed for 5 minutes） systolic blood pressure of A group was lower than group B and C （PB=0.027, PC=0.012）, T2, T4 （anesthesia completed for 3, 10 minutes） diastolic blood pressure of group A was lower than group B and C（P3B=0.001, P3C=0.014;P10B=0.000, P10C=0.043）;T2 （anesthesia completed for 3 minutes） the heart rate of group A was higher than B and C group （PB=0.021, PC=0.009）. The anesthesia duration time of group A was significantly shorter than group B and C （PB=0.000, PC=0.000）. Between the three groups neonatal umbilical artery blood gas and 1, 5 minute Apgar score had no statistical significance （P〉0.05）. The dose of phenylephrine in group A was higher than group B and C （PB=0.001, PC=0.001）, the incidence of pruritus rate of group C was significantly higher than A and B group （P=0.001）. Conclusion Single hyperbaric spinal anesthesia and isobaric spinal anesthesia were suitable anesthesia for cesarean section, but a single needle isobaric spinal anesthesia has faster onset improving the effec

关 键 词：芬太尼 血气分析 阿普加评分 等比重 重比重 

分 类 号：R614[医药卫生—麻醉学]