剖宫产全麻诱导不同用药方案对产妇循环、麻醉深度及新生儿评分影响的比较

目的应用听觉诱发电位指数(AAI)对几种全麻诱导用药方案下产妇的麻醉深度进行监测,并且同时观察对产妇术中循环和新生儿评分的影响,术中知晓发生情况,以期为优化麻醉方案提供依据。方法拟在全麻下行择期剖宫产术足月孕妇60例,随机分为大剂量瑞芬(Ⅰ)组、小剂量瑞芬(Ⅱ)组和氯胺酮(Ⅲ)组3组。分别记录入室后、切皮前、胎儿娩出时、娩出后5min等时点的AAI、血压、心率;记录新生儿1、5、10min Apgar评分,术后1d对术中事件显性记忆。结果 AAI值在胎儿娩出时、娩出后5min两个时点3组间有差异,相邻两组比较差异无统计学意义;3组在胎儿娩出时血压显著高于麻醉前,且3组间差异有统计学意义,Ⅲ>Ⅱ>Ⅰ组;1min Apgar评分,3组新生儿轻度窒息(7～9分)的发生率差异统计学意义,Ⅰ组新生儿轻度窒息的发生率最高P<0.05;Ⅲ组有1例术中知晓。结论第Ⅱ组方案能达到所需的麻醉深度,结合对新生儿评分的影响最小、循环的稳定情况居中,是最佳的用药组合。

Comparison of circulatory system,anesthesia degree ofpuerpera and Apgar score of newborns by different induction regimens of general anesthesia in cesarean section

Objective To compare the effects of different induction regimens of general anesthesia on circulatory system,anesthesia degree of puerpera and Apgar score of newborns monitored by auditory evoked potential index(AAI) in cesarean section,so as to provide basis for optimal anesthesia regimens.Methods Sixty full-term puerpera were enrolled in this study who intended to undergo cesarean section under general anesthesia,and they were randomly divided into three groups: large-dose remifentanil group,low-dose remifentanil group,and ketamine group.The AAI,blood pressure,and heart rate of the puerpera were recorded at the time of entering the operation room,before operation,parturition,5 minutes after parturition.The Apgar scores of newborns at 1,5 and 10 minutes were also recoreded.The explicit memory to the operative events was analyzed 1 day later.Results The difference of AAI values among the three groups was significant at the time of parturition and 5 minutes after parturition.The blood pressure increases significantly after operation and there were significant difference among three groups with a decreased sequence from ketamine group,low-dose remifentanil group,to large-dose remifentanil group.The Apgar score of newborns at 1 minute was significant difference among three groups and the incidence of slight asphyxia in large-dose remifentanil group was the highest,P<0.05.One puerpera in ketamine group had intraoperative awareness.Conclusion Anesthesia regimen with propofol at 1.5mg/kg and remifentanil at 1μg/kg can reach anesthesia depth and is optimal combination regimen based on its effects on the Apgar score of newborns and circulatory status of puerpera.