不同剂量瑞芬太尼麻醉诱导剖宫产手术对母体与胎儿娩出的影响

【目的】比较不同剂量瑞芬太尼麻醉诱导剖宫产手术对母体与胎儿娩出的影响。【方法】选择有椎管内麻醉禁忌证的择期剖宫产手术患者60例，ASAⅠ～Ⅱ级，随机分为 A、B、C三组，每组20例，全身麻醉诱导采用丙泊酚1．5 mg/kg，维库溴铵0．1 mg/kg，瑞芬太尼分别为1．0μg/kg（A组）、1．5μg/kg （B组）、2．0μg/kg（C组），辅助通气2 min后医生切皮开始手术，之后气管插管，进行机械通气，静脉输注瑞芬太尼0．15μg/（kg·min），异丙酚4 mg/（kg·h），间断静脉注入维库溴铵0．05 mg/kg维持麻醉。观察麻醉前（T0）、切皮即刻（T1）、气管插管即刻（T2）的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、出血量、记录诱导至胎儿取出的时间（I～D时间）、1 min，5 min，10 min新生儿 Apgar评分以及新生儿的处理。【结果】三组患者麻醉前 SBP，DBP，MAP、HR组间比较无显著性差异（P＞0．05）。A组T1、T2分别与B和 C组的相同时间点比较 SBP，DBP，MAP、HR明显升高；同时 A组T1、T2与T0比较 SBP，DBP，MAP也明显升高，HR明显增加（P＜0．05）。B组和C组组间和组内比较均无显著性差异。出血量，I～D时间三组组间比较无显著性差异（P＞0．05）。1 min新生儿 Apgar评分C组与 A、B两组比较有显著性差异（P＜0．05），5 min，10 min新生儿 Apgar评分三组组间比较无显著性差异（P＞0．05）。【结论】使用瑞芬太尼1．0μg/kg的诱导剂量，产妇血流动力学不稳定，而2．0μg/kg的诱导剂量，新生儿1min的Apgar评分下降，故1．5μg/kg瑞芬太尼用于剖宫产全身麻醉诱导效果良好，能较好的抑制术中产妇的应激反应，同时对新生儿无不良影响。

Effect of Different Doses of Remifentanil for Anesthesia Induction on Mothers and Fetal Delivery During Cae-sarean Section

Objective]To compare the effects of anesthesia induction with different doses of remifentanil on mother and fe-tal delivery during caesarean section.Methods]A total of 60 ASAⅠ~Ⅱ patients with contraindications of intraspinal anes-thesia undergoing elective caesarean section were chosen and randomly divided into 3 groups with 20 patients in each group. General anesthesia induction was performed with propofol 1.5mg/kg,vecuronium bromide 0.1mg/kg and remifentanil 1.0μg/kg（group A）,1.5μg/kg（group B）and 2.0μg/kg（group C）,respectively.Skin incision and operation were undertaken 20min after the assisted ventilation.Then tracheal intubation was taken for mechanical ventilation.Remifentanil 0.15μg/（kg·min） and propofol 4mg/（kg·h）were injected intravenously.Vecuronium 0.05mg/kg was injected intravenously for maintenance anesthesia.Systolic pressure（SP）,diastolic pressure（DP）,mean arterial pressure（MAP）,heart rate（HR）and bleeding vol-ume before anesthesia（T0 ）,skin incision at once（T1 ）and tracheal intubation at once（T2 ）were observed.Apgar score and treatment of neonates from anesthesia induction to fetal delivery（I-D）,1min,5min and 10min were recorded.Results]There was no significant difference in SP,DP,MAP and HR among 3 groups（P〉0.05）.Compared with group B and group C,SP, DP,MAP and HR in group A at T1 and T2 were obviously increased.Compared with T0,SP,DP,MAP and HR in group A at T1 and T2 were also obviously increased（P 0.05）.Conclusion]Remifentanil 1.0μg/kg for anesthesia induction can maintain stable hemodynamics of parturients,and remifentanil 2.0μg/kg for anesthesia induction can reduce neonatal Apgar score at 1min.Therefore,remifentanile 1.5μg/kg used in general anesthesia induction has good efficacy,and can better inhibit the stress reaction of parturients without adverse effect on neonates.