全身麻醉和硬膜外麻醉行剖宫产术对产妇和新生儿的影响

目的:比较在剖宫产术中全身麻醉和硬膜外麻醉对产妇和新生儿的影响。方法:选择ASAⅠ～Ⅱ级拟行剖宫产术的足月初产妇40例,每组20例,G组施行全身麻醉,E组施行硬膜外麻醉。全身麻醉诱导用氯胺酮和异丙酚,以异丙酚和罗库溴铵维持麻醉,胎儿娩出后静注咪达唑仑和芬太尼;硬膜外麻醉组选择L2～3间隙,注入1.6%利多卡因+0.2%丁卡因。比较两组产妇MAP、HR和SpO2;新生儿剖出时间(I-D),新生儿Apgar评分和行为神经评分(NB-NA)评分。结果:E组手术开始及新生儿剖出时MAP显著低于术前和G组(P<0.05),新生儿剖出时E组HR显著高于术前和G组(P<0.05);两组SpO2比较差异无统计学意义。新生儿剖出时间G组短于E组(P<0.05);新生儿Ap-gar评分和NBNA评分两组比较差异无统计学意义。结论:全身麻醉对产妇的血流动力学影响显著小于硬膜外麻醉,两种麻醉方式对新生儿安全无明显影响。

The effects of general anaesthesia or epidural block on pregnant women and neonates

ObJective： To compare the effects of general anaesthesia and epidural block on pregnant women undergone caesarean section and neonates. Methods ： Forty pregnant women at full term （ ASA Ⅰ - Ⅱ ） undergone caesarean section delivery were allocated to group of general anaesthesia（G group） or epidural block（E group） with 20 in each. G group received induction with ketamine and propofol and were maintained with propofol and rocuronium ,with intravenous injection of midazolam and fentanyl after delivery. Epidural block in E group was performed at the space of L2-3 by administering 1.6% lidocaine ＋ 0. 2% dicaine. The ,data were compared in the two groups concerning MAP,HR and SpO2 of pregnant women, the duration from initial to delivery （I-D）, Apgar scores and neonatal behavioral neurological assessments （ NBNA ）. Results ： MAP at the start of operation and neonate delivery in E group was significant lower than that of pre-operation and G group G（P 〈 0.05 ）. HR at neonate being delivered in group E increased as compared with G group G（ P 〈 0. 05）, but SpO2 showed no statistical difference. G group took longer time than E group by delivery（ P 〈 0.05 ）. There was no difference concerning Apgar and NBNA scores between the two groups. Conclusion：General anaesthesia can produce less effect on hemodynamics for pregnant women undergone caesarean section than epidural block, but the two ways are safe to neonates.