双管硬膜外阻滞和单管硬膜外阻滞麻醉对新生儿神经行为的影响

目的:探讨双管硬膜外阻滞和单管硬膜外阻滞麻醉对新生儿神经行为的影响。方法:选取58例孕妇为研究对象,随机分成2组,双管硬膜外阻滞麻醉组(双管组)和单管硬膜外阻滞麻醉组(单管组),比较两组新生儿1 min和5 min Ap-gar评分、神经行为评分、出生后4天的体重及产妇β-内啡肽含量变化。结果:①新生儿Apgar评分:双管组新生儿Apgar评分与单管组比较,差异无统计学意义(P>0.05);②NACS评分:双管组被动肌张力、主动肌张力、一般反应评分及NACS总分明显高于单管组,差异有统计学意义(P<0.01);③新生儿体重变化:两组母乳喂养新生儿体重在出生即刻、出生后1、2、3天差异均无统计学意义(P>0.05);两组新生儿出生后3天内均发生了明显的生理性脱水,出生后1、2、3天的体重低于出生即刻(P<0.05);出生后1、2、3天体重减轻量双管组少于单管组,出生后1天的体重减轻量差异无统计学意义(P>0.05),出生后2、3天差异有统计学意义(P<0.05)。④β-内啡肽:两组术前24 hβ-内啡肽比较,差异无统计学意义(P>0.05)。术后24 h,双管组β-内啡肽含量明显高于单管组(P<0.01)。结论:双管硬膜外阻滞对新生儿神经行为及适应能力无影响,该方法用于临床无痛分娩安全可靠。

Effects of double-barreled and single-barreled epidural block anesthesia on nervous behavior of neonates

Objective:To explore the effects of double-barreled and single-barreled epidural block anesthesia on nervous behavior of neonates.Methods:58 pregnant women were selected as study objects,then they were divided into two groups randomly: double-barreled epidural block anesthesia group(double-barreled group) and single-barreled epidural block anesthesia group(single-barreled group).One minute and five minutes Apgar scores,nervous behavior scores,body weights on the fourth day after birth,changes of β-endorphin content of pregnant women in the two groups were compared.Results:①Neonatal Apgar scores: there was no significant difference in neonatal Apgar scores between the two groups(P>0.05).②NACS scores: the passive muscular tension score,active muscular tension score,general reaction score and total NACS score of double-barreled group were significantly higher than those of single-barreled group(P<0.01).③Change of neonatal body weight: there was no significant difference in neonatal body weights at the time of birth,at 1,2 and 3 days after birth between the two groups(P>0.05);within three days after birth,the neonates in the two groups were found with physiological dehydration,the body weights at 1,2 and 3 days after birth were significantly lower than those at the time of birth(P<0.05);the losses of body weight at 1,2 and 3 days after birth in double-barreled group were lower than those in single-barreled group,and there was no significant difference in the loss of body weight at one day after birth between the two groups(P>0.05),there was significant difference in the loss of body weight at 2 and 3 days after birth between the two groups(P<0.05).④β-endorphin: there was no significant difference in β-endorphin level at 24 hours before operation between the two groups(P>0.05).At 24 hours after birth,the content of β-endorphin in double-barreled group was significantly higher than that in single-barreled group(P<0.01).Conclusion:Double-barreled epidural block anesthesia has no impact on neonatal nervous behavior and adaptability,and the method is safe and reliable for painless labor in clinic.