高危妊娠剖宫产全身麻醉中瑞芬太尼和异丙酚的应用

摘要

Ob|ective:To study the effect of remifentanil-propofol on neonatus and mothers with high risk pregnancy in obstetric general anesthesia. Methods:46 women with high risk pregnancy who had cesarean section were divided into group I (epidural anesthesia, n = 24) and group Ⅱ (general anesthesia with remifentanil and propofol, n=22). The changes of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate(HR) were observed five times: before, at the beginning of (after the tracheal cannu-la) and 20 minutes in the operation, fetal delivery and at the end of the operation . Apgar scores at 1, 5, 10 minutes after baby delivery, the frequency of the the newborns'tracheal cannula,pH, PaCO2 and PaO2 of umbilical artery, the operation time, blood loss, and the time of baby delivery from the beginning of the operation were compared between the two groups. Results:There were no significant differences in HR, DBP, operative duration .blood loss,the time of baby delivery, Apgar scores of the newborns,the frequency of the the newborns'tracheal cannula,umbilical arterial blood gas (P > 0. 05). The SBP in group I was markedly lower than that in group Ⅱ at the beginning of operation (after the tracheal cannula) ( P < 0. 05). The incidences of left heart failure andhy of mothers during anesthesia and operation in group I were higher than those in group Ⅱ(P<0.05)). Conclusions:Remifentanil-propofol in anesthesia of High-risk pregnancy is a safe, stable, quick palinesthesia. And there is no obviously side effects on the neonates if the drug-taken time and dosage are well controlled.%目的:应用瑞芬太尼和异丙酚对高危妊娠患者剖宫产施行全身麻醉,观察其对新生儿和母体的影响.方法:高危妊娠施行剖宫产患者46例,分成Ⅰ组(硬膜外麻醉)及Ⅱ组(瑞芬太尼和异丙酚全身麻醉).记录术前、手术开始时(即气管插管后时刻)、胎儿娩出时、术中20分钟时及术毕母体的收缩压(SBP)、舒张压(DBP)、心率(HR)；胎儿娩出后1分钟、5分钟Apgar评分及新生儿插管处理率；脐动脉血pH、PCO2、PO2；手术时间、术中失血量、手术开始至胎儿娩出时间.结果:观察各时点的HR、DBP差异无统计学意义.手术开始时Ⅰ组SBP低于Ⅱ组,差异有统计学意义(P＜0.05).手术时间、术中失血量、手术开始至胎儿娩出时间、胎儿娩出后Apgar评分、新生儿插管处理率、脐动脉血气差异无统计学意义(P＞0.05).麻醉及手术过程中母体左心衰和低血压发生率Ⅰ组高于Ⅱ组,差异有统计学意义(P＜0.05).结论:对高危妊娠的剖宫产患者,使用瑞芬太尼和异丙酚进行全身麻醉诱导,安全、平稳、苏醒迅速,掌握好给药时间及剂量对新生儿无明显副反应.