目的 探讨瑞芬太尼在精神分裂症产妇靶控输注中的最合适浓度以及对母婴的影响.方法 择期全身麻醉下行剖宫产术精神分裂症初产妇60例,随机均分为低剂量组(瑞芬太尼2.0 μg/L)、中剂量组(瑞芬太尼3.0μg/L)和高剂量组(瑞芬太尼4.0 μg/L).靶控输注瑞芬太尼至目标血浆靶控浓度,异丙酚2.0 mg/kg静脉注射,罗库溴铵0.6 mg/kg静脉注射,行气管插管术.记录麻醉诱导前(T1)、气管插管后即刻(T2)、切皮时(T3)、胎儿娩出前即刻(T4)及关腹时(T5)产妇的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)和心率(heart rate,HR).记录手术时间、异丙酚用量、术后呼之睁眼时间和拔管时间.分别于出生后1 min和5 min记录新生儿Apgar评分,并记录出生后1h、24 h新生儿行为神经测定评分.结果 与T1比较,低剂量组收缩压、舒张压和心率在T2、T3、T4和T5呈逐渐升高趋势,中剂量组和高剂量组SBP、DBP和HR呈逐渐下降趋势,但在T3和T4有小的波动,3组SBP和HR在组间、组间·时点间交互作用差异均有统计学意义(P＜0.05),而3组DBP在组间、时点间、组间·时点间交互作用差异均有统计学意义(P＜0.05).中剂量组和高剂量组较低剂量组睁眼时间和拔管时间长,高剂量组又较中剂量组拔管时间长,高剂量组异丙酚用量较低剂量组和中剂量组少,差异均有统计学意义(P＜0.05).高剂量组新生儿出生后1 min、5 min Apgar评分及出生后1h、24 h新生儿行为神经测定评分较低剂量组和中剂量组低(P＜0.05).中剂量组和高剂量组产妇桡动脉、新生儿脐静脉中瑞芬太尼血药浓度较低剂量组增高(P＜0.05);高剂量组产妇桡动脉、新生儿脐静脉中瑞芬太尼血药浓度较中剂量组增高(P＜0.05).中剂量组和高剂量组新生儿脐动脉中瑞芬太尼血药浓度高于低剂量组,中剂量组、高剂量组新生儿脐动脉瑞芬太尼浓度/产妇桡动脉瑞芬太尼浓度比值高于低剂量组,高剂量组新生儿脐动脉新生儿行为神经测定/新生儿脐静脉瑞芬太尼浓度比值低于低剂量组,差异均有统计学意义(P＜0.05).结论 瑞芬太尼与异丙酚联合用药具有协同作用.随着瑞芬太尼剂量的增大,其通过胎盘进入胎儿体内的剂量增大,精神分裂症产妇行剖宫产术瑞芬太尼的合适血浆靶控浓度为3.0 μg/L.%Objective To explore the most appropriate concentration of remifentanil targeted infusion in schizophrenia pregnant women underwent cesarean delivery and the impact on mothers and babies.Methods Selected 60 cases of general anesthesia cesarean section schizophrenia primipara were randomly divided into low-dose group(remifentanil 2.0 μg/L),middle-dose group (remifentanil 3.0 μg/L) and high-dose group(remifentanil 4.0 μg/L).With tracheal intubation,remifentanil is administered to target plasma concentrations,with propofol 2.0 mg/kg intravenously,rocuronium 0.6 mg/kg intravenously.The following parameters were recorded:the systolic blood pressure before the induction of anesthesia (T1),immediately after tracheal intubation(T2),incision (T3),immediately before the baby was delivered (T4),closing the abdomen(Ts),systolic arterial pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR),the operation time and the amount of propofol,the recovery time and extubation time at the end of surgery.The Apgar scores of 1 min and 5 min neonates after birth and neonatal neurobehavioral score of 1 h and 24 h were recorded respectively.Results Compared with T1,systolic blood pressure,diastolic blood pressure and heart rate were increased gradually at T2,T3,T4 and T5 in low-dose group,while SBP,DBP and HR were decreased gradually in middledose and high-dose groups,but there was a small fluctuation in T3 and T4.There were significant differences in the SBP and HR in the three groups and among intergroups · time interaction(P＜0.05).However,there were significant differences in the DBP interaction in the three groups,time points and intergroups · time interaction(P＜0.05).The middle-dose group and high-dose group had longer eye opening time and extubation time than those in the low-dose group,the extubation time was longer in the high-dose group than that in the middle-dose group,The dosage of propofol in the high-dose group was lower than that in the low-dose group and middledose group,the difference was statistically significant(P＜0.05).The neonatal 1 min and 5 min Apgar scores after birth and the neonatal behavioral neurological assessmen scores at 1 h and 24 h after birth in high-dose group were lower than that in the lower-dose and middle-dose groups (P＜ 0.05).Remifentanil blood concentration (remifentanil) in maternal radial artery and neonatal umbilical vein in the middle-dose group and the high-dose group were higher than that in the low-dose group(P＜0.05).Remifentanil in maternal radial artery and neonatal umbilical vein in high-dose group were higher than that in the middle-dose group(P＜0.05).Rremifentanil in neonatal umbilical artery in the middle-dose group and high-dose group was higher than that in the low-dose group.Remifentanil ratio of neonatal umbilical artery/maternal radial artery in the middle-dose group and high-dose group was higher than the low-dose group,remifentanil ratio of neonatal umbilical arteryeonatal umbilical vein in high-dose group was lower than the low-dose group,the difference was statistically significant(P＜0.05).Conclusion Remifentanil combined with propofol has a synergistic effect.As the dose of remifentanil increases,the dose of remifentanil increases through the placenta into the fetus.The appropriate plasma target concentration for remifentanil is 3.0 μg/L for schizophrenia pregnant women underwent cesarean section.
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