剖宫产术患者瑞芬太尼-异丙酚-阿曲库铵复合麻醉的效果

目的 探讨瑞芬太尼-异丙酚-阿曲库铵复合麻醉用于剖宫产术患者的效果.方法 全麻剖宫产术患者40例,ASA Ⅰ或Ⅱ级.麻醉诱导:静脉注射瑞芬太尼1 μg/kg、异丙酚1.5 mg/kg和阿曲库铵0.6 mg/kg,气管插管后行机械通气.麻醉维持:静脉输注瑞芬太尼0.15 μg·kg~(-1)·min~(-1),异丙酚4 mg·kg~(-1)·~(-1),间断静脉注射阿曲库铵0.3 mg/kg.取新生儿脐动脉(UA)血样1 ml行血气分析,取UA、脐静脉(UV)和母体动脉(MA)血样各2 ml,以气相色谱.质谱法测定血浆瑞芬太尼浓度(CUV、CUA和CMA).于气管插管前、气管插管即刻、切皮即刻、拔除气管导管即刻记录血液动力学指标,记录苏醒时间和术者满意情况,术后随访术中知晓情况.行新生儿Apgar评分和神经行为学评分(NBNA).结果 所有患者各时点血液动力学平稳,均在正常范围波动.苏醒时间为(5±4)min,未见术中知晓发生.新生儿UA血气分析结果均在正常范围内.新生儿1、5、10 min Apgar评分均大于7分,NBNA均正常.CUV、CUA和CMA分别为(0.65±0.14)、(0.22±0.09)、(0.86±0.25)ng/ml,CUV/CMA和CUA/CUV分别为0.7±0.4和0.35±0.11.结论 瑞芬太尼-异丙酚-阿曲库铵复合麻醉用于削宫产术患者效果良好,对新生儿无不良影响.

Efficacy of remifentanil-propofol-atracurium combined anesthesia for caesarean section

Objective To investigate the efficacy of remifentanil-propofol-atracurium combined anesthesia for caesarean section. Methods Forty ASA Ⅰ or Ⅱ patients, aged 24-30 yr, weighing 60-89 kg, at 38-41 week gestation, scheduled for elective cesarean section under general anesthesia, were studied. Remifentanil 1 μg/kg was slowly injected iv and then infused iv at a rate of 0.15 μg·kg~(-1)·min~(-1) until the end of operation. Propofol 1.5 mg/kg and atracurium 0.6 mg/kg were injected in turn 30 s after remifentauil injection. Mechanical ventilation was performed after tracheal intubation. Atracurium 0.3 mg/kg was intermittently injected iv. Blood samples were taken from umbilical artery (UA) within 1 min after the delivery of the baby for blood gas analysis. Blood samples were simultaneously drawn from UA, umbilical vein (UV), and maternal artery (MA) for determination of plasma remitentanil concentrations (CUA, CUV and CMA) using gas chromatography-mass spectrometry. Systolic blood pressure (SP), diastolic blood pressure (DP), MAP and HR were monitored and recorded before intubation, at the time of inserting the catheter, at skin incision, and at the time of extubation. The analepsia time and satisfactory rate of patients were also recorded. The patient's awareness during operation was noted after operation. Apgar score was performed at 1, 5 and 10 min after the delivery of the newborn. The neonatal behavioral neurological assessment (NBNA) was conducted 1 and 24 h after the delivery of the baby. Results The hemodynamics was stable and varied within the normal range at each time point in all the patients. The analepsia time was (5±4) min and no awareness during operation occurred after postoperative follow-up. The pH value, PaCO_2, PaO_2 and SaO_2 were in the normal range in the neonatal umbilical arterial blood samples. The neonatal Apgar scores at 1, 5 and 10 min after the delivery of the baby were more than 7. NBNA scores were normal. CUV, CUA and CMA were (0.65±0.14), (0.22±0.09) and (0.86±0.25) ng/ml respectively. CUV/CMA and CUA/CUV were 0.7±0.4 and 0.35±0.11 respectively. Conclusion The remifentanil-propofol-atracurium combined anesthesia can produce good anesthetic effect in the patients undergoing cesarean section, with high safety.