不同全身麻醉药物对血小板减少产妇剖宫产术效果及新生儿的影响  

Effects of general anesthesia with different analgesics on thrombocytopenia parturients undergoing cesarean section and their newborns

作　　者：周蜀克[1] 冯继峰[1] 彭伟[1] 池涛[1] ZHOU Shu-ke;FENG Ji-feng;PENG Wei;CHI Tao(Department of Anesthesiology,the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning 530003,China)

机构地区：[1]广西壮族自治区妇幼保健院麻醉科,南宁市530003

出　　处：《广西医学》2020年第15期1973-1976,共4页Guangxi Medical Journal

摘　　要：目的比较应用瑞芬太尼及氯胺酮行全身麻醉对血小板减少产妇剖宫产术效果及新生儿的影响。方法选择在全身麻醉下行剖宫产术的合并血小板减少产妇120例,随机分成氯胺酮组和瑞芬太尼组各60例。氯胺酮组产妇采用氯胺酮进行麻醉诱导,瑞芬太尼组产妇采用瑞芬太尼进行麻醉诱导。比较两组产妇围术期相关指标,气管插管前(T0)、气管插管时(T1)、皮肤切开时(T2)以及拔管时(T3)的平均动脉压和心率,以及新生儿出生后1 min、5 min、10 min Apgar评分及脐动脉血气分析指标。记录产妇在麻醉过程的不良反应发生情况。结果两组产妇的手术时间、术中出血量、拔管所需时间、离室所需时间差异均无统计学意义(均P>0.05)。在T0时点,两组产妇的平均动脉压以及心率差异无统计学意义(P>0.05);在T1、T2、T3时点,瑞芬太尼组产妇的平均动脉压及心率均低于氯胺酮组(均P<0.05)。氯胺酮组产妇T1、T2、T3时点的平均动脉压、心率均高于T0时点(均P<0.05);瑞芬太尼组产妇T1、T2、T3时点的平均动脉压、心率与T 0时点比较,差异均无统计学意义(均P>0.05)。两组新生儿出生后1 min、5 min以及10 min Apgar评分及脐动脉血pH值、PaCO2、PaO2,氧饱和度差异无统计学意义(均P>0.05)。两组产妇麻醉过程均未发生不良反应。结论对于合并血小板减少的产妇,瑞芬太尼和氯胺酮均可用于全身麻醉下行剖宫产,对新生儿无不利影响;但与氯胺酮相比,瑞芬太尼更利于产妇血流动力学稳定。Objective To compare the effects of general anesthesia with remifentanil and ketamine on thrombocytopenia parturients undergoing cesarean section and their newborns.Methods A total of 120 parturients complicated with thrombocytopenia undergoing cesarean section under general anesthesia were enrolled and randomly divided into ketamine group and remifentanil group,with 60 cases in each group.Parturients in the ketamine group used ketamine for anesthesia induction,while parturients in the remifentanil group used remifentanil for anesthesia induction.The two groups were compared in terms of relevant perioperative indices of parturients,mean arterial pressure and heart rate before tracheal intubation(T0),at the moment of tracheal intubation(T1),at the moment of skin incision(T2)and at the moment of extubation(T3),as well as neonatal 1-,5-and 10-minute Apgar scores and umbilical artery blood gas analysis indicators after birth.The incidence of adverse reactions of parturients during anesthesia was recorded.Results There was no statistically significant difference between the two groups in maternal operation duration,intraoperative blood loss,duration to extubation,or time to discharge from operating room(all P>0.05).At T0,no statistically significant difference was found in maternal mean arterial pressure or heart rate between the two groups(P>0.05);at T1,T2 and T3,parturients in the remifentanil group exhibited lower mean arterial pressure and heart rate than the ketamine group(all P<0.05).In the ketamine group,maternal mean arterial pressure and heart rate at T1,T2 and T 3 were higher than those at T0(all P<0.05);in the remifentanil group,maternal mean arterial pressure and heart rate at T1,T2 or T3 did not statistically differ from those at T0(all P>0.05).There was no statistically significant difference between the two groups in neonatal 1-,5-or 10-minute Apgar score after birth,umbilical artery blood pH value,PaCO2,PaO2,or oxygen saturation(all P>0.05).There were no maternal adverse reactions during anesthesia in

关 键 词：血小板减少 全身麻醉 瑞芬太尼 氯胺酮 剖宫产 血流动力学 新生儿 

分 类 号：R614.2[医药卫生—麻醉学] R714[医药卫生—外科学]