七氟醚复合瑞芬太尼在剖宫产术全身麻醉中的临床研究

目的 探讨七氟醚复合瑞芬太尼应用于剖宫产术全身麻醉中的效果,观察其对产妇循环及新生儿的影响,记录术中知晓发生情况,从而评价该方案的安全性与有效性.方法 选取广东省妇幼保健院在全麻下行择期剖宫产术的足月产妇60例,采用随机数字表法分为七氟醚组与异丙酚组,每组30例.分别记录麻醉诱导前、麻醉诱导后、胎儿娩出时、胎儿娩出后5 min各时点的血压、心率;记录胎儿娩出后l、5、10 min的Apgar评分及脐动脉血pH值,观察切子宫至胎儿娩出时间、子宫收缩情况、术中出血量及术中知晓情况.结果 异丙酚组麻醉诱导后、胎儿娩出时平均动脉压、心率明显低于麻醉诱导前（65.4±7.2）、（66.3 ±8.5）mmHg（1 mmHg =0.133 kPa）比（89.1 ±8.3）mmHg,（61.0±9.4）、（63.0±8.4）次/min比（79.0±7.4）次/min] （P ＜0.05）,与七氟醚组麻醉诱导后、胎儿娩出时平均动脉压、心率比较平均动脉压：（65.4±7.2）mmHg比（89.0±8.1）mmHg,（66.3±8.5） mmHg比（92.5±9.7） mmHg;心率：（61.0±9.4）次/min比（79.8±8.0）次/min,（63.0±8.4）次/min比（85.2±9.0）次/min],差异有统计学意义（P＜0.05）.七氟醚组麻醉诱导前、诱导后、胎儿娩生时、胎儿娩生后5 min平均动脉压、心率比较,差异无统计学意义（P＞0.05）平均动脉压：（91.1 ±7.9）mmHg、（89.0±8.1）mmHg、（92.5±9.7） mmHg、（88.9±8.9） mmHg;心率：（83.8±7.7）次/min、（79.8±8.0）次/min、（85.2±9.0）次/min、（80.2±8.0）次/min].2组新生儿出生后l、5、10 min Apgar评分及脐动脉血pH值比较,差异无统计学意义（P＞0.05）（9.1±0.9）分比（9.2±0.7）分、（9.0±1.0）分比（8.8±1.2）分、（9.2±0.6）分比（9.0±0.4）分、（7.3±0.1）比（7.2±0.3）].2组切子宫至胎儿娩出时间、子宫收缩情况及术中失血量比较,差异无统计学意义（P＞0.05）（5.7±2.0）min比（4.6±1.0）min、16.7％ （5/30）比10.0％ （3/30）、（311±114） ml比（299±120） ml].2组均无术中知晓.结论 七氟醚联合瑞芬太尼应用于剖宫产术全身麻醉方案,诱导安全、平稳且可有效预防术中知晓的发生,掌握好给药时间及剂量,对产妇循环、子宫收缩及新生儿无明显影响.

Study of sevoflurane combined with remifentanil on general anesthesia in caesarean section

Objective To discuss the effect on sevoflurane combined with remifentanil on general anesthesia in caesarean section; to observe the influence on maternal circulation and neonates; to record the intraoperative awareness occurrence,in order to evaluate the safety and availability of this scheme.Methods Sixty caesarean section puerperas undergoing general anesthesia of the women and children＇s hospital of Guangdong province were selected,and randomly divided into sevoflurane group and propofol group by random number table,each group had 30 cases.The mean arterial pressure and heart rate in the point before the anesthesia induction,the point after trachea cannula,the point of baby delivery,5 minutes after baby delivery were recorded.The Apgar scores and arteria umbilicalis pH value at points of 1,5,10 minutes after baby delivery were recorded.Time of cut the uterus to fetal childbirth,uterine contraction,operative bleeding and intraoperative awareness were observed.Results The blood pressure and heart rate of propofol group in the point after anesthesia induction,the point of baby delivery were lower than that of the point before the anesthesia induction （65.4 ± 7.2）,（66.3 ± 8.5） mmHg vs （89.1 ± 8.3） mmHg,（61.0 ± 9.4）,（63.0 ± 8.4） times/min vs （79.0 ± 7.4） times/min] （P ＜ 0.05） ; and there were significant differences on the mean arterial pressure and heart rate of propofol group in the point after anesthesia induction,the point of baby delivery when compared with sevoflurane group mean arterial pressure：（65.4 ± 7.2）mmHg vs （89.0 ±8.1）mmHg,（66.3 ±8.5） mmHg vs （92.5 ±9.7）mmHg;heart rate：（61.0 ±9.4）times/min vs （79.8-± 8.0） times/min,（63.0 ± 8.4） times/min vs （85.2 ± 9.0） times/min] （P ＜ 0.05）.The difference in mean arterial pressure and heart rate of in the point before the anesthesia induction,the point after trachea cannula,the point of baby delivery,5 minutes after baby delivery in sevoflurane group had no statistical significance （P ＞ 0.05） mean arterial pressure：（91.1 ± 7.9） mmHg,（89.0 ± 8.1） mmHg; heart rate：（92.5 ± 9.7） mmHg,（88.9 ± 8.9） mmHg,（83.8 ± 7.7） times/min,（79.8 ± 8.0） times/min vs （85.2 ± 9.0） times/min vs （80.2 ± 8.0） times/min].Apgar scores in the time of 1,5,10 min and arteria umbilicalis pH value of all points of neonatus had no statistical significance （P ＞ 0.05） （9.1 ± 0.9） scores vs （9.2 ± 0.7） scores,（9.0 ± 1.0） scores vs （8.8 ± 1.2） scores,（9.2 ± 0.6） scores vs （9.0 ± 0.4） scores,（7.3 ± 0.1） vs （7.2 ± 0.3）].The difference in Time of cut the uterus to fetal childbirth,uterine contraction and operative bleeding between two groups had no statistical significance（P ＞0.05） （5.7 ±2.0）min vs （4.6 ± 1.0）min,16.7％ （5/30）vs 10.0％ （3/30）,（311 ± 114） ml vs （299 ± 120）ml].There were no intraoperative awareness in two groups.Conclusion Applying the sevoflurane compound remifentanil to general anesthesia in caesarean section is safe and steady; it can also effectively prevent the occurrence of intraoperative awareness.