七氟醚复合瑞芬太尼在剖宫产术全身麻醉中的临床研究
칠불미복합서분태니재부궁산술전신마취중적림상연구
Study of sevoflurane combined with remifentanil on general anesthesia in caesarean section
  • 万方数据
    中国医药 중국의약
    CHINA MEDICINE
    2014年 4期 538-542 ,共5页

    贾杰%胡祖荣%危早梅%孙艺娟%邓恋%黄希照

    가걸%호조영%위조매%손예연%산련%황희조

    剖宫产%全身麻醉%七氟醚%瑞芬太尼%异丙酚 剖宮產%全身痳醉%七氟醚%瑞芬太尼%異丙酚
    부궁산%전신마취%칠불미%서분태니%이병분
    Caesarean section%General anesthesia%Sevoflurane%Remifentanil%Propofol
    目的 探讨七氟醚复合瑞芬太尼应用于剖宫产术全身麻醉中的效果,观察其对产妇循环及新生儿的影响,记录术中知晓发生情况,从而评价该方案的安全性与有效性.方法 选取广东省妇幼保健院在全麻下行择期剖宫产术的足月产妇60例,采用随机数字表法分为七氟醚组与异丙酚组,每组30例.分别记录麻醉诱导前、麻醉诱导后、胎儿娩出时、胎儿娩出后5 min各时点的血压、心率;记录胎儿娩出后l、5、10 min的Apgar评分及脐动脉血pH值,观察切子宫至胎儿娩出时间、子宫收缩情况、术中出血量及术中知晓情况.结果 异丙酚组麻醉诱导后、胎儿娩出时平均动脉压、心率明显低于麻醉诱导前[(65.4±7.2)、(66.3 ±8.5)mmHg(1 mmHg =0.133 kPa)比(89.1 ±8.3)mmHg,(61.0±9.4)、(63.0±8.4)次/min比(79.0±7.4)次/min] (P ＜0.05),与七氟醚组麻醉诱导后、胎儿娩出时平均动脉压、心率比较[平均动脉压:(65.4±7.2)mmHg比(89.0±8.1)mmHg,(66.3±8.5) mmHg比(92.5±9.7) mmHg;心率:(61.0±9.4)次/min比(79.8±8.0)次/min,(63.0±8.4)次/min比(85.2±9.0)次/min],差异有统计学意义(P＜0.05).七氟醚组麻醉诱导前、诱导后、胎儿娩生时、胎儿娩生后5 min平均动脉压、心率比较,差异无统计学意义(P＞0.05)[平均动脉压:(91.1 ±7.9)mmHg、(89.0±8.1)mmHg、(92.5±9.7) mmHg、(88.9±8.9) mmHg;心率:(83.8±7.7)次/min、(79.8±8.0)次/min、(85.2±9.0)次/min、(80.2±8.0)次/min].2组新生儿出生后l、5、10 min Apgar评分及脐动脉血pH值比较,差异无统计学意义(P＞0.05)[(9.1±0.9)分比(9.2±0.7)分、(9.0±1.0)分比(8.8±1.2)分、(9.2±0.6)分比(9.0±0.4)分、(7.3±0.1)比(7.2±0.3)].2组切子宫至胎儿娩出时间、子宫收缩情况及术中失血量比较,差异无统计学意义(P＞0.05)[(5.7±2.0)min比(4.6±1.0)min、16.7％ (5/30)比10.0％ (3/30)、(311±114) ml比(299±120) ml].2组均无术中知晓.结论 七氟醚联合瑞芬太尼应用于剖宫产术全身麻醉方案,诱导安全、平稳且可有效预防术中知晓的发生,掌握好给药时间及剂量,对产妇循环、子宫收缩及新生儿无明显影响.
    목적 탐토칠불미복합서분태니응용우부궁산술전신마취중적효과,관찰기대산부순배급신생인적영향,기록술중지효발생정황,종이평개해방안적안전성여유효성.방법 선취광동성부유보건원재전마하행택기부궁산술적족월산부60례,채용수궤수자표법분위칠불미조여이병분조,매조30례.분별기록마취유도전、마취유도후、태인면출시、태인면출후5 min각시점적혈압、심솔;기록태인면출후l、5、10 min적Apgar평분급제동맥혈pH치,관찰절자궁지태인면출시간、자궁수축정황、술중출혈량급술중지효정황.결과 이병분조마취유도후、태인면출시평균동맥압、심솔명현저우마취유도전[(65.4±7.2)、(66.3 ±8.5)mmHg(1 mmHg =0.133 kPa)비(89.1 ±8.3)mmHg,(61.0±9.4)、(63.0±8.4)차/min비(79.0±7.4)차/min] (P ＜0.05),여칠불미조마취유도후、태인면출시평균동맥압、심솔비교[평균동맥압:(65.4±7.2)mmHg비(89.0±8.1)mmHg,(66.3±8.5) mmHg비(92.5±9.7) mmHg;심솔:(61.0±9.4)차/min비(79.8±8.0)차/min,(63.0±8.4)차/min비(85.2±9.0)차/min],차이유통계학의의(P＜0.05).칠불미조마취유도전、유도후、태인면생시、태인면생후5 min평균동맥압、심솔비교,차이무통계학의의(P＞0.05)[평균동맥압:(91.1 ±7.9)mmHg、(89.0±8.1)mmHg、(92.5±9.7) mmHg、(88.9±8.9) mmHg;심솔:(83.8±7.7)차/min、(79.8±8.0)차/min、(85.2±9.0)차/min、(80.2±8.0)차/min].2조신생인출생후l、5、10 min Apgar평분급제동맥혈pH치비교,차이무통계학의의(P＞0.05)[(9.1±0.9)분비(9.2±0.7)분、(9.0±1.0)분비(8.8±1.2)분、(9.2±0.6)분비(9.0±0.4)분、(7.3±0.1)비(7.2±0.3)].2조절자궁지태인면출시간、자궁수축정황급술중실혈량비교,차이무통계학의의(P＞0.05)[(5.7±2.0)min비(4.6±1.0)min、16.7％ (5/30)비10.0％ (3/30)、(311±114) ml비(299±120) ml].2조균무술중지효.결론 칠불미연합서분태니응용우부궁산술전신마취방안,유도안전、평은차가유효예방술중지효적발생,장악호급약시간급제량,대산부순배、자궁수축급신생인무명현영향.
    Objective To discuss the effect on sevoflurane combined with remifentanil on general anesthesia in caesarean section; to observe the influence on maternal circulation and neonates; to record the intraoperative awareness occurrence,in order to evaluate the safety and availability of this scheme.Methods Sixty caesarean section puerperas undergoing general anesthesia of the women and children's hospital of Guangdong province were selected,and randomly divided into sevoflurane group and propofol group by random number table,each group had 30 cases.The mean arterial pressure and heart rate in the point before the anesthesia induction,the point after trachea cannula,the point of baby delivery,5 minutes after baby delivery were recorded.The Apgar scores and arteria umbilicalis pH value at points of 1,5,10 minutes after baby delivery were recorded.Time of cut the uterus to fetal childbirth,uterine contraction,operative bleeding and intraoperative awareness were observed.Results The blood pressure and heart rate of propofol group in the point after anesthesia induction,the point of baby delivery were lower than that of the point before the anesthesia induction [(65.4 ± 7.2),(66.3 ± 8.5) mmHg vs (89.1 ± 8.3) mmHg,(61.0 ± 9.4),(63.0 ± 8.4) times/min vs (79.0 ± 7.4) times/min] (P ＜ 0.05) ; and there were significant differences on the mean arterial pressure and heart rate of propofol group in the point after anesthesia induction,the point of baby delivery when compared with sevoflurane group [mean arterial pressure:(65.4 ± 7.2)mmHg vs (89.0 ±8.1)mmHg,(66.3 ±8.5) mmHg vs (92.5 ±9.7)mmHg;heart rate:(61.0 ±9.4)times/min vs (79.8-± 8.0) times/min,(63.0 ± 8.4) times/min vs (85.2 ± 9.0) times/min] (P ＜ 0.05).The difference in mean arterial pressure and heart rate of in the point before the anesthesia induction,the point after trachea cannula,the point of baby delivery,5 minutes after baby delivery in sevoflurane group had no statistical significance (P ＞ 0.05) [mean arterial pressure:(91.1 ± 7.9) mmHg,(89.0 ± 8.1) mmHg; heart rate:(92.5 ± 9.7) mmHg,(88.9 ± 8.9) mmHg,(83.8 ± 7.7) times/min,(79.8 ± 8.0) times/min vs (85.2 ± 9.0) times/min vs (80.2 ± 8.0) times/min].Apgar scores in the time of 1,5,10 min and arteria umbilicalis pH value of all points of neonatus had no statistical significance (P ＞ 0.05) [(9.1 ± 0.9) scores vs (9.2 ± 0.7) scores,(9.0 ± 1.0) scores vs (8.8 ± 1.2) scores,(9.2 ± 0.6) scores vs (9.0 ± 0.4) scores,(7.3 ± 0.1) vs (7.2 ± 0.3)].The difference in Time of cut the uterus to fetal childbirth,uterine contraction and operative bleeding between two groups had no statistical significance(P ＞0.05) [(5.7 ±2.0)min vs (4.6 ± 1.0)min,16.7％ (5/30)vs 10.0％ (3/30),(311 ± 114) ml vs (299 ± 120)ml].There were no intraoperative awareness in two groups.Conclusion Applying the sevoflurane compound remifentanil to general anesthesia in caesarean section is safe and steady; it can also effectively prevent the occurrence of intraoperative awareness.
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