Narcotrend监测下七氟烷联合瑞芬太尼全身麻醉应用于剖宫产手术对母婴的影响  

Effect of sevoflurane joint remifentanil for general anesthesia under Narcotrend monitoring on maternal and infant in cesarean section surgery

作　　者：倪如飞[1] 王敏霞[2] 刘吉平[1] 叶玉萍[1] 谢威[1] 庄小琦 NI Rufei;WANG Minxia;LIU Jiping;YE Yuping;XIE Wei;ZHUANG Xiaoqi(Department of Anesthesiology,Foshan Maternal and Child Health Care Hospital,Foshan 528000,China;Newborn Pediatrics,Foshan Maternal and Child Health Care Hospital,Foshan 528000,China)

机构地区：[1]广东省佛山市妇幼保健院麻醉科,广东佛山528000 [2]广东省佛山市妇幼保健院新生儿科,广东佛山528000

出　　处：《中国医药科学》2018年第13期127-131,共5页China Medicine And Pharmacy

基　　金：广东省佛山市卫生和计生局医学科研立项课题(20170113)

摘　　要：目的探讨在Narcotrend监测下,七氟烷联合瑞芬太尼全身麻醉应用于剖宫产手术对母婴的影响。方法选取2017年1~6月,行选择性剖宫产的患者100例,随机分为两组,全麻醉(n=50)和腰麻组(n=50)。全麻组采用七氟烷联合瑞芬太尼全身麻醉,术中使用Narcotrend持续监测麻醉深度。腰麻组采用蛛网膜下腔注射0.75%罗哌卡因2m L行单次腰麻,并将麻醉平面控制在T_6水平。观察麻醉诱导前(T0)、切皮即时(T1)、胎儿娩出前(T2)、胎儿娩出后5min(T3)、手术结束时(T4),这5个时间点的产妇的心率、平均动脉压,通过组内对及组间对比,观察七氟烷联合瑞芬太尼全身麻醉对产妇血流动力学的影响。记录两组产妇术中出血量以及术后24h出血量,宫缩情况以及对应处理措施,新生儿1、5、10min Apgar评分以及对应处理措施,观察全麻组对产妇的宫缩以及对新生儿Apgar评分的影响。结果两组产妇在T0时收缩压无明显差异,但是在T1、T2和T3时腰硬组收缩压明显低于全麻组(P<0.05),在T4时两组收缩压又无明显差异(P>0.05)。两组产妇在T0时收缩压无明显差异,但是在T1、T2和T3时腰硬组收缩压明显低于全麻组(P<0.05),在T4时两组收缩压又无明显差异(P>0.05)。全麻组和腰硬组内各时间点的HR分别与T0比较均无明显差异(P>0.05),两组间各时间点的HR比较也均无明显差异(P>0.05)。两组患者产妇术中出血量(P=0.75)和产妇术后24h出血量(P=0.59)均无明显差异(P>0.05)。另外,两组产妇子宫收缩乏力使用χ~2检验发现差异无统计学意义(P=0.31>0.05)。两组患者新生儿出生后各时间点Apgar评分均无统计学意义(P>0.05)。结论七氟烷联合瑞芬太尼全身麻醉应用于剖宫产手术时,与腰麻组相比,产妇血流动力学平稳,未增加产妇术中以及术后24h的出血量,未增加宫缩乏力的发生率,对新生儿Apgar评分无影响,可安全应用于剖宫产手术。Objective To study the effect of sevoflurane joint remifentanil for general anesthesia under Narcotrend monitoring on maternal and infant in cesarean section surgery.Methods From January 2017 to June 2017,100 cases with selective cesarean section were randomly divided into 2 groups,the general anaesthesia group(n=50)and lumbar hemp group(n=50).General anesthesia group was treated with sevoflurane joint fentanyl general anesthesia,Narcotrend was used to monitor the depth of anesthesia during the operation.The lumbar hemp group was treated with subarachnoid injection of 0.75%ropivacaine 2mL for single spinal anesthesia,and the anesthetic level was controlled at T6 level.The heart rate and mean arterial pressure of the 5 time points were observed included before induction of anesthesia(T0),skin cut immediate(T1),fetal delivery(T2),5minafter delivery of the fetus(T3),and at the end of the operation(T4).The effects of sevoflurane combined with remifentanil on hemodynamics were observed through intra group comparison and inter group comparison.The amount of bleeding of parturients,24 hours of bleeding after operation,uterine contraction and corresponding treatment measures,1min,5min,10min Apgar scores of newborn and corresponding treatment measures in two groups were recorded.Effect of general anesthesia group on uterine contraction and neonatal Apgar score were observed.Results There was no significant difference in systolic pressure between the two groups at T0,but in T1,T2 and T3,the systolic pressure in the lumbar hemp group was significantly lower than those in the general anesthesia group(P<0.05),and there was no significant difference in the systolic pressure between the two groups at T4(P>0.05).There was no significant difference in systolic pressure between the two groups at T0,but in T1,T2 and T3,the systolic pressure in the lumbar hemp group was significantly lower than those in the general anesthesia group(P<0.05),and there was no significant difference in the systolic pressure between the two groups at T4(

关 键 词：NARCOTREND 七氟烷 瑞芬太尼 剖宫产 

分 类 号：R614[医药卫生—麻醉学]