曲马多对母婴乳酸盐和新生儿神经行为的影响

目的　研究曲马多对母婴血乳酸盐和新生儿神经行为与适应能力评分 (NACS)的影响。方法　 6 0例足月妊娠剖宫产产妇随机分三组 :T0 组 ,2 0例 ,肌注 0 9%氯化钠 2ml;T1组 2 0例 ,肌注曲马多 1 5mg/kg ;T2 组 ,2 0例 ,肌注曲马多 2mg/kg。各组肌注后开始麻醉 ,三组均采用脊麻与硬膜外联合阻滞。观察指标 :新生儿生后 15min的Apgar评分及新生儿生后 15min的NACS ;胎儿娩出时采脐动、静脉血和母体动脉血各 2ml,行血乳酸值测定及血气分析。结果　三组新生儿Apgar评分无明显差异 ,T0 组NACS明显高于T1组 (P <0 0 5 )和T2 组 (P <0 0 1) ;T2 组脐动、静脉血乳酸值明显高于T1组 (P <0 0 5 )和T0 组 (P <0 0 1) ;母体乳酸值三组间无明显差异 ;T2 组母体和脐动、静脉血PaCO2 明显高于T0 组 (P <0 0 1) ,T2 组脐动、静脉血SaO2 明显低于T0 组 (P <0 0 5 )。结论　剖宫产术前肌注曲马多 1 5mg/kg对新生儿无明显不良影响。但 2mg/kg曲马多肌注具有呼吸抑制作用 ,使脐动、静脉血乳酸盐增加 ,对新生儿NACS有一过性影响

Effect of tramadol on maternal and fetal lactate and neonatal neurolologic and adaptive capacity scores

Objective To study the effect of tramadol on maternal and fetal lactate,neonatal neurologic and adaptive capacity scores(NACS).Methods Sixty termed parturients scheduled for selective caesarean section under combined spinal epidural anesthesia were randomly divided into three groups:group T 0(20 cases,0 9% NaCl 2ml i.m.);group T 1(20 cases,1 5 mg/kg tramadol i.m.);group T 2(20 cases,2 mg/kg tramadol i.m.).Tramadol was administered before anesthesia in all groups.Parameters of 1min,5min neonate Apgar scores,and NACS at 15min age of newborn were evaluated.Samples of umbilical cord blood and maternal arterial blood were taken immediately after delivery for the measurements of blood gas and blood lactate.Results There was no difference in Apgar scores among three groups.NACS in group T 0 was higher than that in group T 1( P< 0 05)and in group T 2( P< 0 01).The lactate of umbilical cord venous and artery in group T 2 was significantly higher than that in T 1( P< 0 05)and T 0( P< 0 01).There was no difference in maternal lactate among three groups.The umbilical cord venous and artery blood SaO 2 was lower( P< 0 05),whereas PaCO 2 was higher ( P< 0 01)in group T 2 than that in group T 0.PaCO 2 of maternal arterial blood was also higher in group T 2 than that in group T 0( P< 0 01).Conclusion Tramadol 1 5 mg/kg intramuscular administration has no side effect on newborns.Tramadol 2 mg/kg i.m.may depress fetal respiration leading to an increase of fetal lactate and has transient side effect on NACS.