七氟醚、丙泊酚顺序喉罩全麻在风心病或风心病矫治术后产妇剖宫产中的应用

目的对七氟醚、丙泊酚顺序喉罩全麻在风湿性心脏病(以下简称风心病)或风心病矫治术后产妇剖宫产中的应用进行临床观察。方法对20例需行抗凝治疗的风心病或风心病矫治术后的剖宫产产妇,采用七氟醚、丙泊酚顺序喉罩全麻,根据患者情况,吸入(6%～8%)七氟醚加(5.0～8.0)L/min氧吸入诱导后,置入喉罩,保留自主呼吸,维持麻醉至胎儿娩出后,停用七氟醚,改用丙泊酚、瑞芬太尼静脉泵注,手术结束前5 min停药,手术结束待病人清醒后拔除喉罩。术前及术中积极防治心衰,加强围产儿的处理。观察麻醉给药前(To)、麻醉给药后置入喉罩前(T1)、置入喉罩时(T2)、切皮时(T3)、胎儿娩出时(T4)、拔除喉罩时(T5)的生命体征,给药到胎儿娩出时间,术中失血量,术中发生心衰病例数,新生儿Apgar评分及苏醒时间。结果各时点生命体征平稳,给药到胎儿娩出时间及苏醒时间短,新生儿Apgar评分正常,无1例出现大出血及心衰。结论配合术前、术中积极正确地防治心衰,改善心功能,加强围产儿处理等综合治疗,七氟醚、丙泊酚顺序喉罩全麻对产妇心功能及胎儿影响小,苏醒时间短,未增加失血量,对风心病或风心病矫治术后产妇剖宫产而言,是一种值得推荐的麻醉方法。

The Application of Sevoflurane, Propofol Laryngeal Mask Sequence General Anesthesia in Cesarean Section in Rheumatic Heart Disease

Objective To Observe the application of sevoflurane,propofol laryngeal mask sequence general anesthesia in cesarean section in rheumatic heart disease（RHD） no operative or postoperative patients.Methods 20 cases parturient with RHD（Some suffered corrective operation） were administrated laryngeal-mask intubation after inhalation of（6%～8%） sevoflurane in（5.0～8.0）L/min oxygen,then inhalation of（2%～3%） sevoflurane in（2.0～3.0）L/min till the newborn delivery,and then used propofol combined with remifentanil to replace sevoflurane till the end of the operation.Improved the heart function before and during the operation.The vital sign at the time point of T0（before anesthesia）,T1（before intubation）,T2（during intubation）,T3（during cutting）,T4（during fetal disengagement）,T5（during extubate） and the volume of blood loss,the rate of heart failure,the time from anesthesia begin to fetal disengagement,the time of palinesthesia and Apgar scores at 0,5 minutes after delivery were all observed.Results The vital sign were stable,the time from anesthesia begin to fetal disengagement and the time of palinesthesia were short.There was no case of hemorrhea or heart failure happened.The Apgar scores were normal at each time point.Conclusion To prevention and cure heart failure,improve heart function before and during the operation,to enhance combined modality therapy,the anesthesia method might be a comfortable and effective general anesthesia,which could apply in cesarean section for parturient who with RHD safely.