中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2012年
11期
1371-1373
,共3页
鲁美静%赵青松%鲁卫华%金孝岠
魯美靜%趙青鬆%魯衛華%金孝岠
로미정%조청송%로위화%금효거
镇痛,产科%镇痛,硬膜外%分娩%氧耗量%胎儿
鎮痛,產科%鎮痛,硬膜外%分娩%氧耗量%胎兒
진통,산과%진통,경막외%분면%양모량%태인
Analgesia,obstetrical%Analgesia,epidural%Labor%Oxygen consumption%Fetus
目的 评价不同分娩方式对胎儿宫内氧合状态的影响.方法 足月单胎头位产妇120例,ASA分级Ⅰ或Ⅱ级,年龄22～32岁,按照分娩方式将产妇分为3组,每组40例.剖宫产组(CS组):经L2,3间隙行穿刺硬膜外麻醉,硬膜外腔注入0.5％罗哌卡因,术中不用辅助药,术后行硬膜外镇痛；分娩镇痛组(LA组):于第一产程开始行L2,3硬膜外常规穿刺头向置管,注入0.125％罗哌卡因+芬太尼2 μg/ml,获得满意镇痛效果后接PCA泵,背景输注速率6～ 10 ml/h,PCA量5 ml,锁定时间20min,宫口开全时停药；自然分娩组(SL组):按正常分娩常规程序处理.术中吸氧,记录新生儿出生后l、5 min时Apgar评分以及15 min和24 h时神经行为与适应能力评分(NACS评分)；胎儿娩出时抽取脐动脉血行血气分析,测定血清乳酸、β-内啡肽(β-EP)、神经肽Y(NP-Y)浓度.结果 3组新生儿出生后1、5 min时Apgar评分,15 min、24 h NACS评分及脐动脉血NP-Y和β-EP浓度差异无统计学意义(P＞0.05)；与CS组比较,SL组脐动脉血乳酸浓度升高,pH值降低,BE绝对值升高,LA组PO2升高,PCO2降低(P＜0.05)；与SL组比较,LA组脐动脉血乳酸浓度降低,pH值升高,BE绝对值降低,PO2升高,PCO2降低(P＜0.05).结论 3种分娩方式下胎儿宫内氧合状态具有显著性意义,但无临床意义.
目的 評價不同分娩方式對胎兒宮內氧閤狀態的影響.方法 足月單胎頭位產婦120例,ASA分級Ⅰ或Ⅱ級,年齡22～32歲,按照分娩方式將產婦分為3組,每組40例.剖宮產組(CS組):經L2,3間隙行穿刺硬膜外痳醉,硬膜外腔註入0.5％囉哌卡因,術中不用輔助藥,術後行硬膜外鎮痛；分娩鎮痛組(LA組):于第一產程開始行L2,3硬膜外常規穿刺頭嚮置管,註入0.125％囉哌卡因+芬太尼2 μg/ml,穫得滿意鎮痛效果後接PCA泵,揹景輸註速率6～ 10 ml/h,PCA量5 ml,鎖定時間20min,宮口開全時停藥；自然分娩組(SL組):按正常分娩常規程序處理.術中吸氧,記錄新生兒齣生後l、5 min時Apgar評分以及15 min和24 h時神經行為與適應能力評分(NACS評分)；胎兒娩齣時抽取臍動脈血行血氣分析,測定血清乳痠、β-內啡肽(β-EP)、神經肽Y(NP-Y)濃度.結果 3組新生兒齣生後1、5 min時Apgar評分,15 min、24 h NACS評分及臍動脈血NP-Y和β-EP濃度差異無統計學意義(P＞0.05)；與CS組比較,SL組臍動脈血乳痠濃度升高,pH值降低,BE絕對值升高,LA組PO2升高,PCO2降低(P＜0.05)；與SL組比較,LA組臍動脈血乳痠濃度降低,pH值升高,BE絕對值降低,PO2升高,PCO2降低(P＜0.05).結論 3種分娩方式下胎兒宮內氧閤狀態具有顯著性意義,但無臨床意義.
목적 평개불동분면방식대태인궁내양합상태적영향.방법 족월단태두위산부120례,ASA분급Ⅰ혹Ⅱ급,년령22～32세,안조분면방식장산부분위3조,매조40례.부궁산조(CS조):경L2,3간극행천자경막외마취,경막외강주입0.5％라고잡인,술중불용보조약,술후행경막외진통；분면진통조(LA조):우제일산정개시행L2,3경막외상규천자두향치관,주입0.125％라고잡인+분태니2 μg/ml,획득만의진통효과후접PCA빙,배경수주속솔6～ 10 ml/h,PCA량5 ml,쇄정시간20min,궁구개전시정약；자연분면조(SL조):안정상분면상규정서처리.술중흡양,기록신생인출생후l、5 min시Apgar평분이급15 min화24 h시신경행위여괄응능력평분(NACS평분)；태인면출시추취제동맥혈행혈기분석,측정혈청유산、β-내배태(β-EP)、신경태Y(NP-Y)농도.결과 3조신생인출생후1、5 min시Apgar평분,15 min、24 h NACS평분급제동맥혈NP-Y화β-EP농도차이무통계학의의(P＞0.05)；여CS조비교,SL조제동맥혈유산농도승고,pH치강저,BE절대치승고,LA조PO2승고,PCO2강저(P＜0.05)；여SL조비교,LA조제동맥혈유산농도강저,pH치승고,BE절대치강저,PO2승고,PCO2강저(P＜0.05).결론 3충분면방식하태인궁내양합상태구유현저성의의,단무림상의의.
Objective To compare the effects of different modes of delivery on arterial oxygen saturation in the fetus.Methods One hundred and twenty ASA Ⅰ or Ⅱ parturients aged 22-32 yr with a single fetus at full term lying in normal headdown position were divided into 3 groups according to the modes of delivery (n =40 each):group cesarean section (group CS) ; group labor analgesia (group LA) and group spontaneous labor (group SL).In group CS cesarean section was performed under epidural anesthesia with 0.5％ ropivacaine.Epidural catheter was placed at L2,3 interspace in groups CS and LA.In group LA labor analgesia was started from the first stage and maintained until complete cervical dilatation.The patients received epidural PCA (PCEA) with O.125 ％ropivacaine plus fentanyl 2 μg/ml.PCEA setting was as follows:a loading dose of 8-10 ml; demand bolus 5 ml;20 min lockout; background infusion 6-10 ml/h.Blood samples were taken from umbilical artery at delivery for blood gas analysis and determination of serum concentrations of lactate,β-endorphin (β-EP) and neuropeptide Y (NP-Y).Apgar score and neurological and adaptive capacity score (NACS) were recorded.Results There was no significant difference in Apgar score,NACS and NP-Y and β-EP concentrations in umbilical arterial blood among the 3 groups.The lactate concentration and the absolute value of BE were significantly higher while pH was lower in group SL than in groups CS and LA.PO2 was significantly higher while PCO2 was lower in group LA than in groups SL and CS,and the lactate concentration and absolute value of BE were significantly lower while pH was higher in group LA than in group SL.Conclusion The 3 modes of delivery have significant effects on arterial oxygenation in fetus but have no clinical significance.
