药学与临床研究
藥學與臨床研究
약학여림상연구
PHARMACEUTICAL AND CLINICAL RESEARCH
2014年
5期
437-441
,共5页
刘丹%王冬娜%王靖宇%付颖
劉丹%王鼕娜%王靖宇%付穎
류단%왕동나%왕정우%부영
全身麻醉%产科%瑞芬太尼%米库氯铵%新生儿%临床用药
全身痳醉%產科%瑞芬太尼%米庫氯銨%新生兒%臨床用藥
전신마취%산과%서분태니%미고록안%신생인%림상용약
General anesthesia%Obstetrics%Remifentanil%Mivacurium%Neonatal%Clinical medication
目的：探讨瑞芬太尼与米库氯铵联合应用于产科全麻的临床效果，评价其可行性和安全性。方法：以38例因椎管内麻醉禁忌症而行全麻剖宫产的产妇为研究对象，随机分为 A、B两组，每组各19例。 A 组：给予丙泊酚+氯胺酮+维库溴铵组合，B 组：给予丙泊酚+瑞芬太尼+米库氯铵组合。观察两组产妇麻醉前、插管后即刻、手术10、20 min 时的 HR、DBP、SBP，记录两组手术开始至胎儿娩出时间、术毕至拔管时间、产妇完全苏醒时间、Steward 评分、新生儿出生后1、5、10 min Apgar 评分、新生儿处理情况以及不良反应等。结果：A 组产妇 HR、SBP、DBP 在麻醉各个节点上有较明显的波动，各个节点之间差异均有统计学意义（P<0.05或 P<0.01）；B 组 HR、DBP、SBP 虽然有一定的波动，但是各个节点数据比较差异均无统计学意义（P>0.05）。两组胎儿娩出时间，新生儿1、5、10 min 时 Apgar 评分以及使用面罩吸氧的新生儿例数均大体相当，组间差异均无统计学意义（P>0.05）。 B 组产妇拔管时间、完全清醒时间较 A 组短，Steward 评分比 A 组高，三个指标组间比较差异均有统计学意义（P<0.05）。结论：全麻剖宫产产妇使用丙泊酚、瑞芬太尼以及米库氯铵组合，产妇血流动力学容易维持稳定，苏醒快，对胎儿/新生儿影响小，可行性好，安全性高，有待于临床进一步研究证实。
目的：探討瑞芬太尼與米庫氯銨聯閤應用于產科全痳的臨床效果，評價其可行性和安全性。方法：以38例因椎管內痳醉禁忌癥而行全痳剖宮產的產婦為研究對象，隨機分為 A、B兩組，每組各19例。 A 組：給予丙泊酚+氯胺酮+維庫溴銨組閤，B 組：給予丙泊酚+瑞芬太尼+米庫氯銨組閤。觀察兩組產婦痳醉前、插管後即刻、手術10、20 min 時的 HR、DBP、SBP，記錄兩組手術開始至胎兒娩齣時間、術畢至拔管時間、產婦完全囌醒時間、Steward 評分、新生兒齣生後1、5、10 min Apgar 評分、新生兒處理情況以及不良反應等。結果：A 組產婦 HR、SBP、DBP 在痳醉各箇節點上有較明顯的波動，各箇節點之間差異均有統計學意義（P<0.05或 P<0.01）；B 組 HR、DBP、SBP 雖然有一定的波動，但是各箇節點數據比較差異均無統計學意義（P>0.05）。兩組胎兒娩齣時間，新生兒1、5、10 min 時 Apgar 評分以及使用麵罩吸氧的新生兒例數均大體相噹，組間差異均無統計學意義（P>0.05）。 B 組產婦拔管時間、完全清醒時間較 A 組短，Steward 評分比 A 組高，三箇指標組間比較差異均有統計學意義（P<0.05）。結論：全痳剖宮產產婦使用丙泊酚、瑞芬太尼以及米庫氯銨組閤，產婦血流動力學容易維持穩定，囌醒快，對胎兒/新生兒影響小，可行性好，安全性高，有待于臨床進一步研究證實。
목적：탐토서분태니여미고록안연합응용우산과전마적림상효과，평개기가행성화안전성。방법：이38례인추관내마취금기증이행전마부궁산적산부위연구대상，수궤분위 A、B량조，매조각19례。 A 조：급여병박분+록알동+유고추안조합，B 조：급여병박분+서분태니+미고록안조합。관찰량조산부마취전、삽관후즉각、수술10、20 min 시적 HR、DBP、SBP，기록량조수술개시지태인면출시간、술필지발관시간、산부완전소성시간、Steward 평분、신생인출생후1、5、10 min Apgar 평분、신생인처리정황이급불량반응등。결과：A 조산부 HR、SBP、DBP 재마취각개절점상유교명현적파동，각개절점지간차이균유통계학의의（P<0.05혹 P<0.01）；B 조 HR、DBP、SBP 수연유일정적파동，단시각개절점수거비교차이균무통계학의의（P>0.05）。량조태인면출시간，신생인1、5、10 min 시 Apgar 평분이급사용면조흡양적신생인례수균대체상당，조간차이균무통계학의의（P>0.05）。 B 조산부발관시간、완전청성시간교 A 조단，Steward 평분비 A 조고，삼개지표조간비교차이균유통계학의의（P<0.05）。결론：전마부궁산산부사용병박분、서분태니이급미고록안조합，산부혈류동역학용역유지은정，소성쾌，대태인/신생인영향소，가행성호，안전성고，유대우림상진일보연구증실。
Objective: To investigate the clinical effect of combined remifentanil with mivacurium in obstetric general anesthesia, and to evaluate its feasibility and safety. Methods: Thirty -eight cases of cesarean section under general anesthesia with intraspinal anesthesia contraindication as the research objects were randomly divided into A, B two groups with 19 patients respectively. Group A was given propofol +ketamine + vecuronium combination, and Propofol + remifentanil + mivacurium combination was for group B. SBP, DBP and HR of the two groups were recorded before anesthesia, after intubation and in operation at 10 min and 20 min. The fetal childbirth time, extubation time, maternal complete recovery time, Steward score, neonatal Apgar scores at 1 min, 5 min and 10 min, neonatal treatment and adverse reactions were observed. Results: In group A, HR, SBP and DBP showed certain fluctuations in anesthesia nodes, the differences were statistically significant (P<0.05 or P<0.01); while those in group B exhibited a certain degree of fluctuations but the differences were not statistically significant (P>0.05). Fetal childbirth time, neonatal Apgar scores at 1min, 5min and 10min, and the cases of neonatal using oxygen masks between the two groups were roughly the same, the differences were not statistically significant (P >0.05). The extubation time, maternal awake time of Group B were shorter than those of group A, the Steward score was higher in Group B than in Group A, the three indexes between the two groups had statistically significant differences (P<0.05). Conclusion: By combining propofol, remifentanil and mivacurium in general anesthesia of obstetrics, the maternal hemodynamics is apt to maintain stable with fast recovery, small fetal/neonatal effects, good feasibility and high security, which needs to be confirmed by further clinical studies.
