纳布啡复合瑞芬太尼与单用瑞芬太尼用于Supreme喉罩全麻剖宫产的临床效果比较  

Comparison of Clinical Effects of Nalbuphine Combined with Remifentanil and Simple Use of Remifentanil for Cesarean Section under General Anesthesia with Supreme Laryngeal Mask Airway

作　　者：连建烽 赵爱月[2] 肖全胜[1] LIAN Jianfeng;ZHAO Aiyue;XIAO Quansheng(Quanzhou Women’s and Children’s Hospital,Quanzhou 362000,China)

机构地区：[1]福建省泉州市儿童医院·妇幼保健院,福建泉州362000 [2]福建医科大学附属第二医院

出　　处：《中国医学创新》2019年第29期73-77,共5页Medical Innovation of China

基　　金：泉州市科技局项目(2018Z157)

摘　　要：目的:探讨纳布啡复合瑞芬太尼用于剖宫产全身麻醉的可行性和优越性。方法:选择2018年6-12月在泉州市妇幼保健院麻醉科实施择期全麻剖宫产的60例足月产妇,随机分为两组,瑞芬太尼复合纳布啡组(Ⅰ组,n=30)、瑞芬太尼复合生理盐水组(Ⅱ组,n=30),在不同时段观察比较两组心率(HR)、脉搏氧饱和度、平均动脉压(MAP)、Narcotrend指数、Apgar评分及新生儿脐动静脉血气。结果:两组胎儿娩出后1、5、10 min的Apgar评分比较,差异均无统计学意义(P>0.05)。两组产妇诱导后1 min(T2)和插喉罩后1 min(T3)时点MAP、HR较基线值(T0)均有所下降,但两组比较差异均无统计学意义(P>0.05)。Ⅰ组产妇切皮时(T4)和胎儿娩出时(T5)HR、MAP均较Ⅱ组低,差异均有统计学意义(P<0.05)。结论:纳布啡复合瑞芬太尼有效地钝化了全麻剖宫产期间产妇的血流动力学波动,同时对新生儿Apgar评分无不良影响,复合使用纳布啡可以减少过量使用瑞芬太尼对新生儿呼吸抑制的副作用。Objective: To explore the feasibility and superiority of Nalbuphine combined with Remifentanil in general anesthesia for cesarean section. Method: From June to December 2018, 60 full-term parturients who underwent elective general anesthesia cesarean section in Anesthesiology Department of Quanzhou Maternal and Child Health Hospital were randomly divided into two groups, Remifentanil combined with Nalbuphine group(Ⅰ group, 30 cases), Remifentanil combined with Saline group(Ⅱ group, 30 cases), the maternal heart rate, pulse oxygen saturation, mean arterial pressure, Narcotrend index values, Apgar score and neonatal umbilical artery blood gas of two groups at different times were observed and compared. Result: There were no significant differences in Apgar scores between two groups at 1, 5 and 10 min after delivery(P>0.05). MAP and HR at 1 min(T2) after induction and 1 min(T3) after laryngeal mask insertion in both two groups were decreased, but compared with baseline values(T0) there were no statistically significant differences between two groups(P>0.05). The heart rate(HR) and average arterial pressure(MAP) of Ⅰ group were lower than those of Ⅱ group at the time of skin cutting(T4) and at the time of delivery(T5), the differences were statistically significant(P<0.05). Conclusion: Remifentanil combined with Nalbuphine can effectively blunt the hemodynamic fluctuation during cesarean section under general anesthesia. Combined with Nalbuphine can reduce the side effects of excessive use of Remifentanil on neonatal respiratory depression.

关 键 词：全身麻醉 剖宫产 Supreme双腔喉罩 纳布啡 瑞芬太尼 

分 类 号：R[医药卫生]