硬膜外腔麻醉和腰硬联合麻醉对剖宫产中新生儿Apgar评分影响的比较

目的比较硬膜外腔麻醉（EA）和腰硬联合麻醉（SCEA）对剖宫产中新生儿Apgar评分影响。方法选择1995～1998年3年中在EA下剖宫产病例和2005～2008年3年中在SCEA下剖宫产病例,入选病例分别为2 484例和3 032例。收集并记录最高阻滞平面、局麻药用量、麻醉诱导至胎儿娩出时间（I-D）、子宫切开至胎儿娩出时间（U-D）;收集并记录新生儿1、5、10 min Apgar评分,收集并记录新生儿Apgar评分低于7分的各项具体评分。结果 EA组与SCEA组比较,EA组的I-D和U-D都明显高于SCEA组（P〈0.01或P〈0.05）,EA组利多卡因和布比卡因的总用量明显多于SCEA组（P〈0.01）;出婴后1～10 min Apgar评分低于7分的新生儿总例数EA组明显多于SCEA组（P〈0.05）;在Apgar评分低于7分新生儿的具体各项评分中,出婴后1、5、10 min EA组新生儿的肌肉张力明显低于SCEA组（P〈0.01）,出婴后1、5 min EA组新生儿的呼吸评分低于SCEA组（P〈0.05）,出婴后1 min EA组新生儿的皮肤颜色和刺激反射评分都低于SCEA组（P〈0.05）。结论在剖宫产中,EA组Apgar评分低于7分的新生儿明显多于SCEA组,这与局麻药用量大和麻醉诱导至胎儿娩出时间长关联性大。在SCEA中局麻药对新生儿Apgar评分影响甚少。

Comparison of the effect on the Apgar score of newborn in cesarean section by epidural anesthesia or spine-epidural anesthesia

Objective To compare the effect on the Apgar score of newborn in cesarean section by epidural anesthesia(EA) or spine-epidural anesthesia(SCEA).Methods 2 484 cases and 3 032 cases were collected respectively in cesarean section under the EA during the period from 1995 to 1998 and under the SCEA during the period from 2005 to 2008.The highest block level,local anesthetic dosage,the duration between the induction of anesthesia and delivery,the duration between uterine incision and delivery were collected and recorded;Apgar score of the newborn(1 min,5 min,10 min) and Apgar score below 7 were also collected and recorded.Results The ID or UD of EA group were significantly higher than the SCEA group(P < 0.01 or P < 0.05),the EA group’s total dosage of L and B were much more than the SCEA group(P < 0.01).The newborn infants with Apgar score(1-10 min) below 7 in EA group were more than the SCEA group(P < 0.05).The EA group which Apgar score below 7,muscle tension were weaker than the SCEA group after the infants birthed 1 min,5 min and 10 min(P < 0.01),the EA group’s respiratory score were significantly lower than the SCEA group after infants birthed 1 min,5 min(P < 0.05),the EA group’s scores of skin color and stimulate reflection were significantly lower than the SCEA group after infants birthed 1 min(P < 0.05).Conclusion The newborn with Apgar score below 7 in the EA group were significantly more than the SCEA group in cesarean section.It is close relationship with local anesthetics and the duration between the induction of anesthesia and delivery.The local anesthetics in SCEA have little impact on the Apgar score.