全身麻醉用于剖宫产手术的临床观察

目的:观察全身麻醉用于剖宫产手术对母婴安全的影响.方法:对32例有椎管内麻醉禁忌的产妇采用气管内插管全身麻醉.术前常规给予东莨菪碱0.3 mg,麻醉诱导用芬太尼0.1 mg,阿曲库铵0.3 mg/kg.依托咪酯0.3 mg/kg快速诱导插管.胎儿娩出后追加芬太尼0.1 mg,静脉泵注丙泊酚、瑞芬太尼复合液(丙泊酚:瑞芬太尼=200:1)15～20 mL/h,间断推注阿曲库铵维持麻醉.记录诱导前、插管时,插管后5 min产妇的HR、SpO2、MAP;观察并记录诱导至胎儿娩出的时间及新生儿1分钟,5分钟,10分钟时的Apgar评分.结果:母体在气管插管时HR、MAP均有不同程度的升高,无一例反流误吸,术中生命体征平稳.术后有1例产妇因心脏病情危重转入ICU外,其余均平安返病房.1例胎儿娩出时间12分钟,1分钟Apgar评分为5分外,其余均≥8分,10分钟Apgar评分均≥9.5分.结论:术前准备充分,在产科医生和麻醉医生的密切配合下,全身麻醉用于剖宫产术对母婴是安全可行的.

Clinical observation of general anesthesia for cesarean section

Objective：To investigate the effect of general anesthesia on safety of child and maternal in cesarean section.Methods：32 puerperas with spinal anesthesia contraindication undergoing general intro-tracheal intubation anesthesia were observed.Preoperative routine to puerperas with the scopolamine 0.3mg,anesthesia was induced rapidly with fentanyl 0.1mg,atracurium 0.3 mg/kg and 0.3 mg/ kg etomidate.To add fentanyl 0.1 mg after the baby was delivered,and to maintain anesthesia with intravenous infusion of propofol and remifentanil solution （propofol vs.remifentanil=200：1）15～20 ml/h and intermittent bolus atracurium.HR,SpO2,MAP of the puerpera were recorded before induction, on the time of intubation and 5 min after intubation; observed and recorded the time of anesthesia induction to the newborn fetus and the Apgar score on the time of 1 min,5 min, 10 min after the newborn delivery.Results：HR,MAP of the puerpera were increased in varying degrees during tracheal intubation.No reflux aspiration occurred,and the vital signs were safe during operation.After operation,one case was moved into ICU ward due to severe heart disease,the ather cases were safely returned to general ward after operation.One baby was delivered for 12 min,which 1 min Apgar score was 5 points,the rest were ≥8 points,all baby 10 min Apgar scores were ≥9.5 points.Conclusion：With good preparation before operation and close coordination between anesthesiologists and obstetricians,general intro-tracheal intubation anesthesia for cesarean section is safe and feasible to the child and puerpera.