异丙酚用于剖宫产的胎盘转移和对新生儿的影响

Neonatal effects and placental transfer of propofol during cesarean section

目的观察硬膜外阻滞下行剖宫产的产妇辅以异丙酚的胎盘转移和对新生儿的影响。方法选择ASAI-II级择期或急诊行剖宫产手术的孕足月产妇45例,在硬膜外阻滞成功后按所给异丙酚用量随机分成三组:I组异丙酚1mg/kg,II组异丙酚1.5mg/kg,III组异丙酚2mg/kg。于胎儿娩出时抽取产妇静脉血、脐动脉血、脐静脉血进行异丙酚浓度的测定及脐动静脉血气分析,评估新生儿出生后1、5、10minApgar评分及30min、2h、24h的神经行为(NBNA)。结果胎儿娩出时脐静脉可测出异丙酚浓度I组(0.42±0.05)μg/ml、II组(0.48±0.06)μg/ml、III组(0.80±0.04)μg/ml,脐动脉可测出异丙酚浓度I组(0.37±0.08)μg/ml、II组(0.49±0.03)μg/ml、III组(0.58±0.04)μg/ml,脐静脉与产妇静脉异丙酚浓度比值I、II、III组分别为0.89、0.86、0.94,脐静脉与脐动脉异丙酚浓度比值I、II、III组分别为0.88、1.02、0.73。脐动静脉血气分析,新生儿出生后1、5、10minApgar评分及30min、2h、24h的神经行为评分基本在正常值范围。结论异丙酚用于剖宫产能通过胎盘屏障,但在本研究用量未出现对新生儿明显的抑制作用。

Objective To investigate neonatal effects and placental transfer of propofol during cesarean section with epidural analgesia. Methods 45 pregnant women needing caesarean section （ASAⅠ-Ⅱ） were divided into three groups by the using dose of propofol： group Ⅰ propofol 1 mg/kg,group Ⅱ propofoll. 5 mg/kg, groupⅢ propofol 2 mg/kg. At delivery maternal venous （ MV ） and umbilical arterial （ UA ）, umbilical venous （UV） samples were obtained. The propofol concentration was measured with high performance liquid chromatography（HPLC）. Neonatal Apgar scores after being taken out 1,5 ,10 minunts,umbilical cord blood gas analysis and neonatal behavioral neurological aseessment（NBNA） after delivery 30 rain ,2 h, 24 h were recorded. Results At delivery propofol crossed the placenta as demonstrated by concentrations found＇in umbilical venous （ 0.42 ±0. 05 ） μg/ml , （ 0. 48 ± 0.06 ） μg/ml, （ 0. 80 ± 0. 04 ） μg/ml, umbilical arterial （ 0. 37± 0. 08 ） μg/ ml, （ 0. 49 ± 0. 03 ） μg/ml, （ 0. 58 ± 0.04 ） μg/ml in group Ⅰ, Ⅱ, Ⅲ. The ratio of propofol concentration in the umbilical venous blood to that maternal venous blood was 0. 89,0. 86,0. 94 and the ratio of propofol concentration in the umbilical arterial to that umbilical venous blood was 0. 88,1.02,0. 73. Newborn＇Apgar scores after delivery 1,5,10 minunts ,NBNA 30 min,2 h、24 h and umbilical cord blood gas analysis were at normal range of value. Conclusion Propofol can pass through placenta during cesarean section, but the using dose of this research willn＇ t bring obvious repression on infant.