三种静脉复合全身麻醉在剖腹产中的比较

目的：探讨三种静脉复合全身麻醉方法对产妇和新生儿的影响。方法：120例足月妊娠产妇,ASA评分（1~2）级,随机分为3组（n=40）,丙泊酚组（A组）、丙泊酚复合瑞芬太尼组（B组）、丙泊酚复合氯胺酮组（C组）,麻醉诱导后气管插管,机械通气。分别观察各组产妇麻醉诱导前、诱导后、切皮时心率（HR）、平均动脉压（MAP）、血氧饱和度（SPO2）变化,术中知晓发生率,新生儿1分钟、5分钟Apgar评分、新生儿第一次呼吸时间、以及使用辅助呼吸、胸外按压和药物复苏例数。结果：A组产妇HR和MAP麻醉诱导前、后和切皮时变化明显,组内比较差异有显著性（P〈0.05）,A、B组产妇麻醉诱导后低血压发生率明显高于C组（P〈0.05）。新生儿第一次呼吸时间A组和B组长于C组（P〈0.05）,使用辅助呼吸例数和胸外按压例数A、B组多于C组（P〈0.05）。结论：丙泊酚复合氯胺酮对产妇循环影响小,对新生儿影响轻微,是一种比较理想的麻醉方法。

Comparison of Compound Intravenous General Anesthesia among Three Therapies in Caesarean Operation

Objective： To observe effects of three therapies of compound intravenous anesthesia on maternal and neonatal in caesarean operation. Methods： 120 full term pregnancy women with ASA（ 1 - 2） grade were divided into randomLy the three groups of 40 each： propofol group（ A group）,fentanyl plus propofol group（ B group） and propofol plus ketamine group（ C group）. Endotracheal intubation and mechanical ventilation were conducted after anesthesia induction in three groups,and observing the changes of HR、MAP,SPO2,rate of awareness and skin incision time before and after induction; neonatal breathing for the first time,assisted breath and neonatal Apgar score were recorded too. Results： Intra- group comparison： HR and MAP had a significant change（ P〈0. 05） at skin incision,before and after induction in A group; and lower BP was in A and B group as compared with C group（ P〈0. 05） after anesthesia induction. The breathing for the first time and assisted breath were more available for neonatal in A and B group than that in C group（ P〈0. 05）. Conclusions： The propofol plus ketamine general anesthesia therapy is more efficiency and light of influence for caesarean operation in clinic.