CAJ | 학술논문

目的探讨剖宫产术中异丙酚对新生儿的影响及其胎盘转移情况.方法拟行剖宫产术的足月初产妇60例,ASA Ⅰ或Ⅱ级,年龄23～31岁,体重59～89kg,身高156～169 cm,随机分为2组(n=30):全麻组(G组)和硬膜外麻醉组(E组).G组静脉注射异丙酚2 mg/kg和琥珀胆碱2 mg/kg快速诱导气管插管,行机械通气,局麻辅助下开始手术.胎儿娩出结扎脐带后立即抽取脐静脉(UV)、脐动脉(UA)血样各5 ml,经足背动脉取母体动脉(MA)血样5 ml,采用高效液相色谱法测定血浆异丙酚浓度(CUV、CUA和CMA);E组经L_(1,2)行硬膜外麻醉,给予2%利多卡因11～17 ml,控制感觉阻滞平面上界为T6～8.于入室5 min(T_0),切皮即刻(T_1)、新生儿娩出(T_2)和手术结束(T_3)时记录心率(HR)、脉搏血氧饱和度(SpO_2)和平均动脉压(MAP);记录分娩时间和给药结束到钳夹脐动脉、静脉的时间;胎儿娩出后1、5 min时行Apgar评分.结果 G组给药结束到钳夹脐动、静脉的时间短于E组(P<0.05),两组新生儿Apgar评分、各时点HR、SpO_2和MAP比较差异无统计学意义(P>0.05),两组均未见新生儿呼吸抑制发生,G组术后随访均未发生术中知晓.CMA、CUV和CUA分别为(1.4±0.4)、(0.86±0.25)、(0.70±0.22)μg/ml,CUV/CMA和CUA/CUV分别为0.61±0.11和0.80±0.10.结论静脉注射异丙酚2 mg/kg用于剖宫产术麻醉效果满意,虽然易通过胎盘,且在胎儿体内代谢慢,但并未对新生儿产生不良影响.
목적 탐토부궁산술중이병분대신생인적영향급기태반전이정황.방법 의행부궁산술적족월초산부60례,ASA Ⅰ혹Ⅱ급,년령23～31세,체중59～89kg,신고156～169 cm,수궤분위2조(n=30):전마조(G조)화경막외마취조(E조).G조정맥주사이병분2 mg/kg화호박담감2 mg/kg쾌속유도기관삽관,행궤계통기,국마보조하개시수술.태인면출결찰제대후립즉추취제정맥(UV)、제동맥(UA)혈양각5 ml,경족배동맥취모체동맥(MA)혈양5 ml,채용고효액상색보법측정혈장이병분농도(CUV、CUA화CMA);E조경L_(1,2)행경막외마취,급여2%리다잡인11～17 ml,공제감각조체평면상계위T6～8.우입실5 min(T_0),절피즉각(T_1)、신생인면출(T_2)화수술결속(T_3)시기록심솔(HR)、맥박혈양포화도(SpO_2)화평균동맥압(MAP);기록분면시간화급약결속도겸협제동맥、정맥적시간;태인면출후1、5 min시행Apgar평분.결과 G조급약결속도겸협제동、정맥적시간단우E조(P<0.05),량조신생인Apgar평분、각시점HR、SpO_2화MAP비교차이무통계학의의(P>0.05),량조균미견신생인호흡억제발생,G조술후수방균미발생술중지효.CMA、CUV화CUA분별위(1.4±0.4)、(0.86±0.25)、(0.70±0.22)μg/ml,CUV/CMA화CUA/CUV분별위0.61±0.11화0.80±0.10.결론 정맥주사이병분2 mg/kg용우부궁산술마취효과만의,수연역통과태반,차재태인체내대사만,단병미대신생인산생불량영향.
Objective To investigate the placental transfer and neonatal effects of propefol for cesarean section. Methods Sixty ASA Ⅰ or Ⅱ parturicnts at full term, aged 23-31 yr, weighing 59-98 kg, height 156-169 cm, undergoing elective cesarean section under general anesthesia, were randomly divided into 2 groups (n = 30 each): general anesthesia group (group G) and epidural anesthesia group (group E). Group G received iv injection of propofol 2 mg/kg and sueeinyleholine 2 mg/kg to facilitate tracheal intubation. Blood samples of 5 ml were drawn from umbilical vein (UV) and artery (UA), and maternal artery (MA) after ligation of the umbilical cords respectively for determination of plasma propofol concentrations (CUV, CUA and CMA) by HPLC. Epidural anesthesia was performed at L_(1,2) interspace, 2% lidocaine 11-17 ml was administered and the upper spread of sensory block reached T6-8. HB, SpO_2 and MAP were recorded after the parturients had settled down for 5 min in the operating room (T_0), at skin incision (T_1), after delivery of the baby (T_2), and at the end of operation (T_3) in both groups. The delivery time (duration between uterus incision and delivery of the baby), duration between the end of administration and clamping of UA and UV, and Apgar score at 1 and 5 min after delivery were also recorded. Results The duration between the end of administration and clamping of UA and UV was significantly shorter in group G than in group E (P < 0.05), while no significant differences were found in Apgar score and HR, SpO_2 and MAP at each time point between the two groups (P > 0.05). No neonatal respiratory depression in both groups and no intraoperative awareness in group G occurred. The plasma concentrations of propofol were (1.4±0.4), (0.86±0.25) and (0.70±0.22) μg/ml in maternal arterial, and umbilical venous and arterial blood samples respectively. CUV/CMA and CUA/CUV were 0.61±0.11 and 0.80± 0.10 respectively. Conclusion The anesthetic efficacy of propofol 2 mg/kg was satisfactory for cesarean section, and it has no adverse effects on the newborn although the metabolism is slow after easy placental transfer.