瑞芬太尼在妊娠期高血压疾病产妇剖宫产术中的应用

目的:瑞芬太尼复合硬膜外麻醉用于患妊娠期高血压疾病产妇剖宫产,观察其对产妇及新生儿的影响,评价瑞芬太尼用于妊娠期高血压疾病剖宫产的有效性和安全性。方法:选择患妊娠期高血压疾病需行剖宫产的产妇90例,分成瑞芬太尼复合硬膜外麻醉组(A组)、硬膜外麻醉组(B组)和腰硬联合麻醉组(C组),每组30例。观察3组产妇围手术期的血流动力学参数,评估麻醉效果,观察围手术期不良反应的发生、血管活性药物的使用、胎儿血气情况、胎儿娩出后Apgar评分以及进行新生儿神经行为评分(NBNA)。结果:A组和B组产妇围手术期血流动力学参数差异无统计学意义(P>0.05),血流动力学稳定性明显优于C组(P<0.05)。A组和C组产妇麻醉效果差异无统计学意义(P>0.05),明显优于B组(P<0.05)。3组新生儿脐动脉血气分析及胎儿娩出后的Apgar评分和NBNA评分比较差异无统计学意义(P>0.05)。结论:瑞芬太尼复合硬膜外麻醉用于妊娠期高血压疾病的剖宫产术,产妇围手术期的血流动力学平稳,麻醉效果满意,对新生儿无明显不良影响。

Application of Remifentanil in caesarean delivered women with hypertensive disorder complicating pregnancy

Objective:To observe the impact of Remifentanil combined with epidural anesthesia applied in caesarean delivered women with hypertensive disorder complicating pregnancy(HDP) on maternal and neonatal,and evaluated the efficacy and safety of Remifentanil for caesarean delivered women with HDP.Methods:All 90 women with HDP were divided into three groups: the Remifentanil combined with epidural anesthetic group(group A),the epidural anesthetic group(group B) and the spinal-epidural anesthetic group(group C) Then the maternal perioperative hemodynamic parameters,the effects of anesthesia,adverse reaction,use of vasoactive drugs,the fetal blood gas,the fetal Apgar scores after delivery,neonatal behavioral neurological(NBNA) were observed.Results:The differences of maternal perioperative hemodynamic parameters between group A and group B were statistically significant(P>0.05),hemodynamic stability was significantly better than that of group C(P<0.05).There were no significance in maternal anesthetic effect between group A and group C(P>0.05),but the maternal anesthetic effect of the two groups were significantly better than that of group B(P<0.05).The differences of Apgar score,umbilical arterial blood gas analysis,and fetus NBNA score were not statistically significant among the three groups(P>0.05).Conclusion:Remifentanil combined with epidural anesthesia for caesarean delivered women with HDP can obtain the maternal hemodynamic stability and satisfactory anesthesia in perioperative period,no significant adverse effects on the newborn.