国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2010年
6期
492-494,498
,共4页
七氟醚%丙泊酚%Supreme喉罩%全身麻醉%剖宫产
七氟醚%丙泊酚%Supreme喉罩%全身痳醉%剖宮產
칠불미%병박분%Supreme후조%전신마취%부궁산
Sevoflurane%Propofol%Supreme laryngeal mask%General anesthesia%Cesarean section
目的 对Supreme喉罩联合七氟醚、丙泊酚顺序全麻在剖宫产中的应用进行临床观察.方法 60例ASA Ⅰ～Ⅱ级择期剖宫产的足月初产妇采用完全随机分为两组,每组30例,A组采用Supreme喉罩联合七氟醚、丙泊酚顺序全麻,吸入6%～8%七氟醚加5 L/min～8 L/min氧诱导,置入Supreme喉罩,以2%～3%七氟醚加2 L/min～3 L/min氧维持麻醉至胎儿娩出,停七氟醚,改用丙泊酚、瑞芬太尼联合静脉泵注;B组采用腰硬联合麻醉,取L2-3或L3-4穿刺,蛛网膜下腔给予0.5%罗哌卡因9 mg～12 mg.两组产妇若出现术中低血压,经快速补液无法改善者予麻黄素纠正.观察两组产妇麻醉开始至手术开始时间,失血量,术中低血压发生率,麻黄素使用病例数,麻醉相关并发症发生率及出生后即刻、5 min、10 min的新生儿Apgar评分.结果 A组麻醉开始至手术开始时间较B组短[(5.2±1.7)min vs(15.8±5.6)min,P＜0.05];A组术中低血压发生率、麻黄碱使用率及麻酢相关并发症发生率分别为0.00%、0.00%、3.33%,分别低于B组的40.00%、33.33%、23.33%,差异有统计学意义(P＜0.05);两组失血量及新生儿Apgar评分差异均无统计学意义.结论 Supreme喉罩联合七氟醚、丙泊酚顺序全麻的主要优势在于吸入适当浓度的七氟醚对胎儿影响小,胎儿娩出后改用静脉麻醉减少了七氟醚对宫缩的影响,不增加失血量,术中低血压发生率低,且Supreme喉罩无需使用肌松剂,能有效防止返流、误吸,术后恢复快,是一种可安全应用于剖宫产于术的全身麻醉方法.
目的 對Supreme喉罩聯閤七氟醚、丙泊酚順序全痳在剖宮產中的應用進行臨床觀察.方法 60例ASA Ⅰ～Ⅱ級擇期剖宮產的足月初產婦採用完全隨機分為兩組,每組30例,A組採用Supreme喉罩聯閤七氟醚、丙泊酚順序全痳,吸入6%～8%七氟醚加5 L/min～8 L/min氧誘導,置入Supreme喉罩,以2%～3%七氟醚加2 L/min～3 L/min氧維持痳醉至胎兒娩齣,停七氟醚,改用丙泊酚、瑞芬太尼聯閤靜脈泵註;B組採用腰硬聯閤痳醉,取L2-3或L3-4穿刺,蛛網膜下腔給予0.5%囉哌卡因9 mg～12 mg.兩組產婦若齣現術中低血壓,經快速補液無法改善者予痳黃素糾正.觀察兩組產婦痳醉開始至手術開始時間,失血量,術中低血壓髮生率,痳黃素使用病例數,痳醉相關併髮癥髮生率及齣生後即刻、5 min、10 min的新生兒Apgar評分.結果 A組痳醉開始至手術開始時間較B組短[(5.2±1.7)min vs(15.8±5.6)min,P＜0.05];A組術中低血壓髮生率、痳黃堿使用率及痳酢相關併髮癥髮生率分彆為0.00%、0.00%、3.33%,分彆低于B組的40.00%、33.33%、23.33%,差異有統計學意義(P＜0.05);兩組失血量及新生兒Apgar評分差異均無統計學意義.結論 Supreme喉罩聯閤七氟醚、丙泊酚順序全痳的主要優勢在于吸入適噹濃度的七氟醚對胎兒影響小,胎兒娩齣後改用靜脈痳醉減少瞭七氟醚對宮縮的影響,不增加失血量,術中低血壓髮生率低,且Supreme喉罩無需使用肌鬆劑,能有效防止返流、誤吸,術後恢複快,是一種可安全應用于剖宮產于術的全身痳醉方法.
목적 대Supreme후조연합칠불미、병박분순서전마재부궁산중적응용진행림상관찰.방법 60례ASA Ⅰ～Ⅱ급택기부궁산적족월초산부채용완전수궤분위량조,매조30례,A조채용Supreme후조연합칠불미、병박분순서전마,흡입6%～8%칠불미가5 L/min～8 L/min양유도,치입Supreme후조,이2%～3%칠불미가2 L/min～3 L/min양유지마취지태인면출,정칠불미,개용병박분、서분태니연합정맥빙주;B조채용요경연합마취,취L2-3혹L3-4천자,주망막하강급여0.5%라고잡인9 mg～12 mg.량조산부약출현술중저혈압,경쾌속보액무법개선자여마황소규정.관찰량조산부마취개시지수술개시시간,실혈량,술중저혈압발생솔,마황소사용병례수,마취상관병발증발생솔급출생후즉각、5 min、10 min적신생인Apgar평분.결과 A조마취개시지수술개시시간교B조단[(5.2±1.7)min vs(15.8±5.6)min,P＜0.05];A조술중저혈압발생솔、마황감사용솔급마작상관병발증발생솔분별위0.00%、0.00%、3.33%,분별저우B조적40.00%、33.33%、23.33%,차이유통계학의의(P＜0.05);량조실혈량급신생인Apgar평분차이균무통계학의의.결론 Supreme후조연합칠불미、병박분순서전마적주요우세재우흡입괄당농도적칠불미대태인영향소,태인면출후개용정맥마취감소료칠불미대궁축적영향,불증가실혈량,술중저혈압발생솔저,차Supreme후조무수사용기송제,능유효방지반류、오흡,술후회복쾌,시일충가안전응용우부궁산우술적전신마취방법.
Objective To observe the application of Supreme laryngeal make combining with sevoflurane-propofol sequence general anesthesia in the Cesarean section. Methods 60 patients were randomly divided into sevoflurane-propofol sequence general combine with Supreme laryngeal mask group (group A ) and spinal-epidural anesthesia group (group B ). Group A was administrated Supreme laryngeal-mask intubation after inhalation of 6%-8% sevoflurane in 5 L/min -8 L/min oxygen, then inhalation of 2%-3% sevoflurane in 2 L/min -3 L/min till the newborn delivery, and then used propofol combine with remifentanil to replace sevoflurane till the end of the operation. Group B was performed with spinal injection of ropivacaine 9 mg-12 mg. The parturient undergone hypotension which could not recovered by fluid replacement was intravenous injection of ephedrine. Effect-acting time of anesthesia volume of blood loss, rate of low blood pressure and dosage of ephedrine, complication of anesthesia and Apgar scores at 0,5 and 10 minutes after delivery were recorded. Results The effect-acting time of anesthesia in group B (15.8±5.6) min was longer than that (5.2±1.7) min in group A(P＜0.05).The rate of low blood pressure (0.00%), the rate of ephedrine to use(0.00% ) and complication of anesthesia (3.33%) in group A were all lower than those (40.00%, 33.33%, 23.33%) in group B (P＜0.05). The volume of blood loss and the Apgar scores at each time points were similar( P＞0.05 ). Conclusion The effect of sevoflurane to the foetus is little and intravenous anesthesia replaced sevoflurane after the newborn delivery can reduce the effect of sevoflurane to the uterine contraction.And Supreme laryngeal mask can prevent back flow and aspiration efficiently. So the Superme laryngeal mask combining with sevoflurane-propofol sequence general anesthesia is a comfortable and effective general anesthesia, which can apply in the Cesarean section safely.
