瑞芬太尼复合地氟烷全身麻醉用于剖宫产术的临床观察  

Application remifentanil combined with desflurane in general anesthesia for cesarean section

作　　者：李晓燕[1] 李浩[2] 庹鹏 王寿平[1] LI Xiaoyan;LI Hao;TUO Peng;WANG Shouping(Department of Anesthesiology ,the Third A. ffiliated Hospital of Guangzhou Medical University ,Guangzhou 510150,China;Department of Anesthesiology,the Fifth Affiliated Hospital of Guangzhou Medical University ,Guangzhou 510700,China)

机构地区：[1]广州医科大学附属第三医院麻醉科,广州510150 [2]广州医科大学附属第五医院麻醉科,广州510700

出　　处：《中华实用诊断与治疗杂志》2019年第7期708-711,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：广东省自然科学基金面上项目(S2012010009065)

摘　　要：目的 探讨瑞芬太尼复合地氟烷全身麻醉对行剖宫产产妇及新生儿的影响.方法 瑞芬太尼复合地氟烷全身麻醉下行剖宫产术产妇737例,依据麻醉诱导开始至胎儿娩出(induction to fetal delivery,ID)的时间分为A1组313例(I-D时间≤15 min),A2组332例(>15 min~<60 min),A3组92例(I-D时间≥60 min);比较3组产妇入室时(T0)、麻醉诱导时(T1)、气管插管即刻(T2)、切皮时(T3)、胎儿娩出时(T4)、手术结束时(T5)、拔除气管导管时(T6)、出室时(T7)平均动脉压(mean arterial pressure,MAP)、心率及新生儿脐动脉血pH值,1、5、10 min Apgar评分.结果 3组产妇T0~T7 MAP、心率在组内及组间比较差异均无统计学意义(P>0.05);A1组、A2组、A3组新生儿5 min Apgar评分[(9.6±1.0)、(9.6±0.7)、(9.4±0.9)分]、10 min Apgar评分[(9.9±0.5)、(9.9±0.4)、(9.9±0.4)分]均高于1 min Apgar评分[(8.4±1.8)、(8.3±1.5)、(6.7±1.6)分](P<0.05),A1组、A2组新生儿1 min Apgar评分高于A3组(P<0.05),3组新生儿5、10 min Apgar评分及脐动脉血pH值比较差异无统计学意义(P>0.05).结论 瑞芬太尼复合地氟烷全身麻醉下行剖宫产术,可维持血流动力学稳定,长时间(I-D时间≥60 min)联合应用可影响胎儿宫内呼吸,但不影响新生儿呼吸功能及脐动脉血pH值.Objective To investigate the maternal and neonatal influences of remifentanil combined with desflurane in general anesthesia for caesarean section. Methods According to the time from the beginning of anesthesia induction to fetal delivery (I-D), 737 parturients undergoing caesarean section under general anesthesia using remifentanil combined with desflurane were divided into Al group (n = 313, I-D≤15 min), A2 group (n= 332, I-D: 15-60 min) and A3 group (n = 92, I-D≥60 min). The mean arterial pressure and heart rate at the time points of entering the operating room (To), induction of anesthesia (Ti ), immediately after endotracheal intubation (T2), skin incision (T3 ). delivery of fetus (T4), end of operation (T5 ), extubation of trachea catheter (T6) and leaving the operating room (T7 ) in the parturient women, as well as the pH values of umbilical arterial blood and 1, 5 and 10 min Apgar scores in the neonates were compared among three groups. Results The MAP and heart rate showed no significant differences at T0 to T7 among three groups (P<0. 05). The 5 min Apgar scores (9.6±1.0, 9. 6±0. 7, 9. 4±0. 9) and 10 min Apgar scores (9. 9±0. 5 , 9. 9±0. 4, 9. 9±0. 4) were significantly higher than 1 min Apgar scores (8. 4± 1. 8,8.3± 1. 5 , 6. 7± 1. 6) in Al, A2 and A3 groups (P<0. 05), 1 min Apgar score was significantly higher in Al and A2 groups than that in A3 group (P<0. 05), and 5 and 10 min Apgar scores as well as pH values showed no significant differences among three groups (P>0. 05).Conclusion Remifentanil combined with desflurane in general anesthesia for cesarean section can maintain hemodynamic stability. Long-time use of them two (I-D≥60 min) would affect fetal intrauterine respiration, but not affect neonatal respiratory function and umbilical cord blood pH value.

关 键 词：剖宫产术 瑞芬太尼 地氟烷 全身麻醉 

分 类 号：R614[医药卫生—麻醉学]