喉罩通气全身麻醉与硬脊膜外腔阻滞和蛛网膜下腔阻滞麻醉用于剖宫产的比较

目的比较喉罩通气全身麻醉、硬脊膜外腔阻滞和蛛网膜下腔阻滞3种麻醉方式对新生儿及产妇术后恢复的影响。方法择期行剖宫产术的产妇90名,随机分为全身麻醉、硬脊膜外腔阻滞和蛛网膜下腔阻滞组。全身麻醉组产妇依次静脉注射维库溴铵2mg、氯胺酮30～40mg、丙泊酚1.0mg/kg、琥珀胆碱1.5mg/kg麻醉诱导后插入喉罩,吸入体积分数为0.010～0.015的七氟烷维持麻醉。胎儿娩出后适当给予产妇芬太尼、咪达唑仑和曲马多。3组均于胎儿娩出即刻抽取胎儿脐动脉血行血气分析,并记录新生儿出生1和5min时的Apgar评分以及出生后1、2、3和5d时的神经行为评分(分别记录为NBNA1、2、3、5)。记录术后1和24h时产妇的疼痛数字分级评分(分别记录为NRS1、24),术中知晓、恶心呕吐发生率,以及术后肠道恢复通气时间和开始哺乳时间。结果 3组间新生儿出生1和5min Apgar评分及NBNA1、2、3、5评分的差异均无统计学意义(P值均>0.05),脐动脉血气分析指标均在正常范围内。3组的NRS1均<3分,全身麻醉组显著低于硬脊膜外腔阻滞组和蛛网膜下腔阻滞组(P值均<0.01),3组间肠道恢复通气时间和开始哺乳时间的差异均无统计学意义(P值均>0.05)。结论喉罩用于全身麻醉剖宫产对母婴是安全的,对产妇术后恢复也无不良影响。

Comparison of laryngeal mask ventilation anesthesia, epidural anesthesia and spinal anesthesia in cesarean section

Objective To compare the effect of laryngeal mask ventilation anesthesia, epidural anesthesia and spinal anesthesia on neonatal and maternal postoperative recovery. Methods Ninety patients scheduled for elective cesarean section were randomly divided into general anesthesia group, epidural anesthesia group and spinal anesthesia group. General anesthesia was induced with vecuronium 2 mg, ketamine 30-40mg, propofol 1.0 mg/kg, succinylcholine 1.5 mg/kg by intravenous injection in order. Then a laryngeal mask was intubated. Sevoflurane 1.0%-1.5% in oxygen was administered to maintain anesthesia. Fentanyl, midazolam and Tramal were appropriately given after delivery. We collected blood samples from umbilical artery after delivery for blood gas analysis, and recorded 1-min and 5-min Apgar scores and numerical rating scale 1 h and 24 h (NRS1 and NRS24) after surgery, and neonatal behavioral neurological assessment (NBNA) 1 d, 2 d, 3 d and 5 d after birth in all newborns. Anesthesia awareness during surgery, nausea and vomiting, breast-feeding and gastrointestinal function recovery were observed during the follow up. Results There were no significant differences in Apgar scores or NBNA 1 d, 2 d, 3 d, 5 d among the three groups (all P>0.05). Neither were the starting time of breast-feeding and intestinal recovery ventilation time (all P>0.05). All the results of umbilical arterial blood gas analysis were within the normal range. NRS1 of all the parturients were less than 3. NRS1 in general anesthesia group was significantly lower than those in the other two groups (both P<0.01). Conclusion Laryngeal mask in general anesthesia is safe for cesarean section, with no adverse effects on newborns and maternal postoperative recovery.