不同全麻方式对剖宫产术母婴的影响  

Effect of Different General Anesthesia on Mother and Infant of Cesarean Section

作　　者：吕忠杰 李红梅 沈洪波 苗国庆 LYU Zhong-jie;LI Hong-mei;SHEN Hong-bo;MIAO Guo-qing(Department of Anesthesiology, Beijing Wuzhou Women and Children Hospital, Beijing, 100022 China)

机构地区：[1]北京五洲妇儿医院麻醉科

出　　处：《中外医疗》2019年第17期66-69,共4页China & Foreign Medical Treatment

摘　　要：目的观察并比较静吸复合麻醉(ICA)和全凭静脉麻醉(TIVA)两种不同全麻方式对剖宫产手术产妇和新生儿的影响。方法方便选取2014年4月—2018年1月在该院产科接受在全身麻醉行剖宫产手术的72例产妇,分为TIVA(n=35例)组和ICA组(n=37例)。监测并记录患者在麻醉诱导前(t0)、麻醉诱导后(t1)、手术开始(t2)以及胎儿娩出时(t3),收缩压(SBP)、舒张压(DBP)、心率(HR)和麻醉深度(BIS)基础值。另外,观察比较两种麻醉方式对新生儿Apgar1min和5min评分的影响。结果两组受试产妇手术时间、术中失血量和补液量差异无统计学意义(t=1.013、0.618、0.813,P>0.05)。经诱导麻醉后,两组产妇血压均有所降低,与基础值相比,TIVA组产妇t1时,ICA组产妇在t1和t2时,SBP和DBP值差异有统计学意义(P<0.05)。但是TIVA组产妇各时间点HR较稳定,而ICA组产妇手术过程中HR较低,在t1、t2、t3时,与基础值和TIVA组相比都差异有统计学意义(P<0.05)。麻醉诱导后,与基础值相比,在t1和t2时,BIS都有显著的降低(P<0.05)。ICA组产妇麻醉程度更深,在t1和t2时,与TIVA组产妇BIS比较,差异有统计学意义(P<0.05)。手术结束后,两组产妇开始慢慢苏醒,TIVA组产妇苏醒速度更快,两组产妇BIS比较,差异有统计学意义(P<0.05)。产后两组胎儿5minApgar评分较1minApgar评分均有所升高,差异有统计学意义(t=13.678、7.726,P<0.05)。结论静吸复合麻醉和全凭静脉麻醉都具有良好的麻醉效果和母婴安全性,且各具有一定的优势,均值得临床推广。Objective To observe and compare the effects of two different general anesthesia methods, such as intravenous anesthesia (ICA) and total intravenous anesthesia (TIVA), on maternal and neonatal cesarean section. Methods From April 2014 to January 2018,conveniently selected 72 women who underwent cesarean section in general anesthesia in our hospital were divided into TIVA (n=35 cases) group and ICA group (n=37 cases). Monitor and record patients before anesthesia induction (t0), post-anesthesia induction (t1), start of surgery (t2), and fetal delivery (t3), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and anesthesia depth (BIS) base value. In addition, the effects of the two anesthesia methods on the Apgar 1 min and 5 min scores of neonates were compared. Results There was no significant difference in the operation time, intraoperative blood loss and fluid volume between the two groups (t=1.013,0.618,0.813,P>0.05). After induction of anesthesia, the blood pressure of the two groups was reduced. Compared with the baseline value, the TIB group had a t1 and t2, and the SBP and DBP values were statistically significant different at the t1 and t2(P<0.05). However, the HR of the women in the TIVA group was stable at each time point, while the HR was lower during the ICA group. At t1, t2, and t3, there were statistically significant differences compared with the baseline and TIVA groups(P<0.05). After induction of anesthesia, compared with the baseline values, BIS was significantly reduced at t1 and t2(P<0.05). Maternal anesthesia in the ICA group was more severe. At t1 and t2, compared with the maternal BIS in the TIVA group(P<0.05). After the operation, the two groups of women began to slowly wake up, TIVA group maternal recovery speed is faster, the two groups of maternal BIS comparison(P<0.05). The 5 min Apgar scores of the fetuses in the postpartum group were higher than those in the 1 min Apgar score (t=13.678,7.72 6, P<0.05). Conclusion Both static anesthesia and total intravenou

关 键 词：静吸复合麻醉 全凭静脉麻醉 剖宫产手术 血流动力学 新生儿Apgar评分 

分 类 号：R7[医药卫生—临床医学]