两种麻醉方法对剖宫产新生儿脐血pH值和Apgar评分的影响

Influence of Two Kinds of Anesthesia to pH Value of the Umbilical Cord Blood and Apgar Scores of the Neonates Delivered by Cesarean Section

【目的】通过对剖宫产术时新生儿脐血血气和Apgar评分的分析,探讨全身麻醉和硬膜外阻滞两种不同麻醉方法对胎儿安全性的影响。【方法】足月单胎妊娠胎位异常者行择期剖宫产的产妇中,选择血小板计数<50×109/L的病例行全身麻醉(全麻组),血小板≥50×109/L者行硬膜外阻滞(硬膜外组),两组各25例。两组产妇均在胎儿娩出时抽取脐动、静脉血,进行血气分析。分别记录两组胎儿娩出时间、手术时间、1 min和5 min Apgar评分,并比较这些指标和血气分析指标。【结果】全麻组和硬膜外组新生儿1 min Apgar评分分别为(9.5±1.1)(、9.8±0.7)分,5 min Apgar评分均为10分,两组比较,差异均无显著性(P>0.05)。胎儿娩出时脐动、静脉血的pH值在全麻组分别为(7.31±0.06)和(7.31±0.04),硬膜外组分别为(7.28±0.07)和(7.32±0.05),两组比较,差异均无显著性(P>0.05)。【结论】全身麻醉和硬膜外阻滞均可安全地用于剖宫产。

[Objeetive]To determine the safety of regular doses of general and epidural anesthesia on nconates delivered by cesarean sections. [Methods]Singleton pregnant women for whom elective cesarean sections were planned after 37 gestational weeks were allocated to general anesthesia group（platelet count 〈50×10^9/ L） or epidural anesthesia group （platelet eount≥50 ×10^9/L）. Arterial and venous blood samples were withdrawn from the doubly clamped umbilical cord segment at delivery for the pH, bicarbonate, PO2, ,and PCO2. All delivery times,birth weights, and Apgar scores at 1 min,5min were recorded. [Results]The mean Apgar score at 1 min for the general anesthesia group was （9.5±1.1） and （9.8±0. 7） for the epidural anesthesia group, without significant difference（ P 〉0.05）. The Apgar scores at 5min of all newborns were 10. The mean umbilical arterial and venous blood pH for the general anesthesia group were （ 7.31±0.06 ）, （ 7.31±0.04 ）, and （7.28±0.07）, （7. 32±0. 05 ） for the epidureal anesthesia group respectively. No significant differnce was found between the two groups （ P 〉0.05）. [Conelusion]Our prospective study suggests that mode of anesthesia does not influence significantly the outcome of newborn infants delivered by elective cesarean section. It seems that both general and epidural anesthesia can be used in elective cesarean sections safely.