联合瑞芬太尼和米库氯铵在产科全麻中的临床应用研究

目的：探讨瑞芬太尼与米库氯铵联合应用于产科全麻的临床效果，评价其可行性和安全性。方法：以38例因椎管内麻醉禁忌症而行全麻剖宫产的产妇为研究对象，随机分为 A、B两组，每组各19例。 A 组：给予丙泊酚+氯胺酮+维库溴铵组合，B 组：给予丙泊酚+瑞芬太尼+米库氯铵组合。观察两组产妇麻醉前、插管后即刻、手术10、20 min 时的 HR、DBP、SBP，记录两组手术开始至胎儿娩出时间、术毕至拔管时间、产妇完全苏醒时间、Steward 评分、新生儿出生后1、5、10 min Apgar 评分、新生儿处理情况以及不良反应等。结果：A 组产妇 HR、SBP、DBP 在麻醉各个节点上有较明显的波动，各个节点之间差异均有统计学意义（P<0.05或 P<0.01）；B 组 HR、DBP、SBP 虽然有一定的波动，但是各个节点数据比较差异均无统计学意义（P>0.05）。两组胎儿娩出时间，新生儿1、5、10 min 时 Apgar 评分以及使用面罩吸氧的新生儿例数均大体相当，组间差异均无统计学意义（P>0.05）。 B 组产妇拔管时间、完全清醒时间较 A 组短，Steward 评分比 A 组高，三个指标组间比较差异均有统计学意义（P<0.05）。结论：全麻剖宫产产妇使用丙泊酚、瑞芬太尼以及米库氯铵组合，产妇血流动力学容易维持稳定，苏醒快，对胎儿/新生儿影响小，可行性好，安全性高，有待于临床进一步研究证实。

Clinical Using of Combined Remifentanil with Mivacurium in Obstetric General Anesthesia

Objective: To investigate the clinical effect of combined remifentanil with mivacurium in obstetric general anesthesia, and to evaluate its feasibility and safety. Methods: Thirty-eight cases of cesarean section under general anesthesia with intraspinal anesthesia contraindication as the research objects were randomly divided into A, B two groups with 19 patients respectively. Group A was given propofol + ketamine + vecuronium combination, and Propofol + remifentanil + mivacurium combination was for group B. SBP, DBP and HR of the two groups were recorded before anesthesia, after intubation and in operation at 10 min and 20 min. The fetal childbirth time, extubation time, maternal complete recovery time, Steward score, neonatal Apgar scores at 1 min, 5 min and 10 min, neonatal treatment and adverse reactions were observed. Results: In group A, HR, SBP and DBP showed certain fluctuations in anesthesia nodes, the differences were statistically significant (P<0.05 or P<0.01); while those in group B exhibited a certain degree of fluctuations but the differences were not statistically significant (P>0.05). Fetal childbirth time, neonatal Apgar scores at 1min, 5min and 10min, and the cases of neonatal using oxygen masks between the two groups were roughly the same, the differences were not statistically significant (P>0.05). The extubation time, maternal awake time of Group B were shorter than those of group A, the Steward score was higher in Group B than in Group A, the three indexes between the two groups had statistically significant differences (P<0.05). Conclusion: By combining propofol, remifentanil and mivacurium in general anesthesia of obstetrics, the maternal hemodynamics is apt to maintain stable with fast recovery, small fetal/neonatal effects, good feasibility and high security, which needs to be confirmed by further clinical studies.