预防新生儿窒息产妇术前纳洛酮给药方式探讨

目的:观察胎儿窘迫产妇术前不同方式给予纳洛酮对剖宫产新生儿的影响,选择一种预防新生儿窒息更有效的给药方式。方法:选择满足手术条件的胎儿窘迫产妇499例,随机分为两组。观察组(n=216)术前4～6 h静脉滴入0.1 mg/mg纳洛酮,间隔0.5～1 h重复1～2次;治疗组(n=233)术前4～6 h泵注纳洛酮8 mg至胎儿剖出,速度为8 ml/h。新生儿剖出未呼吸前夹脐带两端,抽取脐动脉血3 ml做血气分析。同时对新生儿进行即刻Apgar评分,两组Apgar评分8～10分、4～7分、0～3分各段随机采集10例新生儿脐静脉血4 ml,测血浆β-EP水平。结果:两组新生儿剖出即刻正常和轻度窒息率无统计学差异(P>0.05),重度窒息新生儿数观察组比治疗组高(χ2=6.280,P=0.013)。治疗组新生儿酸中毒症状轻,脐动脉血气pH、PaCO2、PaO2、HCO3-值优于观察组(P<0.05)。正常和轻度窒息新生儿脐静脉血β-EP水平两组无统计学差异(P>0.05),重度窒息新生儿脐静脉血β-EP水平观察组明显高于治疗组(P<0.05)。随着新生儿窒息程度减轻,脐静脉血β-EP水平降低。两种方式给药后,显效新生儿数治疗组明显高于观察组(χ2=5.402,P=0.023);有效新生儿数两组无统计学差异(χ2=3.789,P=0.064),无效率观察组比治疗组高(χ2=6.230,P=0.018)。结论:胎儿窘迫产妇术前4～6 h纳洛酮持续泵注比多次静脉滴入更能有效预防新生儿窒息。

Exploration on maternal preoperative administrative patterns of naloxone for preventing neonatal asphyxia

Objective:To observe the effect of different administrative patterns of naloxone before cesarean section among pregnant women with fetal distress on neonates,and choose a more effective administrative pattern to prevent neonatal asphyxia.Methods:A total of 499 pregnant women with fetal distress meeting surgical criteria were randomly divided into two groups: 216 patients in observation group were treated with intravenous drip of naloxone(0.1 mg/mg) at 4-6 hours before cesarean section,the treatment was repeated for 1-2 times every 0.5-1 hour;233 patients in treatment group were treated with pump injection of naloxone(8 mg) at 4-6 hours before cesarean section until delivery,the speed was 8 ml/h.Both ends of umbilical cords of neonates after birth were clipped before respiration,3 ml umbilical artery blood was Abstracted for blood gas analysis.Apgar score was conducted immediately,4 ml umbilical venous blood samples of 10 neonates whose Apgar scores were 8-10,4-7,and 0-3 were randomly collected,plasma β-EP levels were detected.Results:There was no statistically significant difference in the incidence rate of mild asphyxia at birth between the two groups(P>0.05),the number of neonates with severe asphyxia in observation group was statistically significantly higher than that in treatment group(χ2=6.280,P=0.013).The symptoms of neonatal acidosis in treatment group were mild,the levels of pH value,PaCO2,PaO2,and HCO3-detected by blood gas analysis were superior to those in observation group(P<0.05).There was no statistically significant difference in β-EP level in umbilical venous blood between neonates without asphyxia and neonates with mild asphyxia(P>0.05),the level of β-EP in umbilical venous blood of neonates with severe asphyxia in observation group was statistically significantly higher than that in treatment group(P<0.05).The level of β-EP in umbilical venous blood decreased with alleviation of degree of neonatal asphyxia.The obviously effective rate in treatment group was statistically significantly higher than that in observation group(χ2=5.402,P=0.023);there was no statistically significant difference in the effective rate between the two groups(χ2=3.789,P=0.064),the ineffective rate in observation group was statistically significantly higher than that in treatment group(χ2=6.230,P=0.018).Conclusion:Continuous pump injection of naloxone at 4-6 hours before cesarean section in pregnant women with fetal distress can more effectively prevent neonatal asphyxia compared with intravenous drip of naloxone for many times.