七氟醚吸入麻醉在急诊剖宫产的应用

Clinical Application of Sevoflurane Inhalation General Anaesthesia in Emergency Cesarean Section

目的:比较七氟醚吸入全身麻醉与传统全身麻醉方式在急诊剖宫产中的应用。方法:将加例ASAⅠ-Ⅱ级拟行急诊剖宫产的孕产妇随机分为两组,七氟醚组(A组20例),阿曲库铵组(B组20例),两组患者麻醉诱导用药相同,麻醉维持:A组吸入呼气末浓度<3%的七氟醚,胎儿娩出后静脉推注芬太尼2ug/kg,B组则吸入0.5%～1.5%异氟烷维持浅麻醉,胎儿娩出后静脉推注阿曲库铵0.2mg/kg和芬太尼2ug/kg,待术者关闭腹膜层时即关闭A组七氟醚或B组异氟烷,同时开大氧流量至6L/min,加快麻醉气体的排除。记录两组患者胎儿娩出时5min的Apgar评分,手术时间、出血量、缩宫素用量、术毕至拔管时间、术毕至离室时间。结果:A组术毕至拔管时间、术毕至离室时间均比B组时间短,两者比较有统计学意义(P<0.05)。结论:七氟醚吸入麻醉用于急诊剖宫产可缩短产妇术毕至拔管时间和术毕至离室时间,可能有助于降低残余肌松对产妇的生理影响,提高麻醉的安全性。

Objective： To compare the difference of sevoflurane inhalation general anaesthesia with traditional general anaesthesia. Method： 40 expectant mothers operated in an emergency who ranked ASA Ⅰ-Ⅱ level, were randomly divided into sevoflurane group （A） and atracurium group（B）.Two groups were induced in the same way.anaesthesia maintenance：patients in A group were inspired 〈3% scvoflurane by the end of expiration,then administrated 2ug/kg fentanyl by intravenous injection after foetus delivery; Patients in B group were inspired 0.5%- 1.5%isoflurane, then administrated 2ug/kg fentanyl and 0.2mg/kg Atracurinm .We turned off the sevoflurane or isoflurane after dosing the abdominal membrane, and turned oxygen up to 6L/min,so as to discharge the anaesthesia gas quikly.We recorded the Apgar score when foetus delivery and after 5min, the time of operation,the quantity of hemorrhage, the amount of oxytocin,the extubation time after operation and the time of leaving operation room.Results： The extubation time after operation and the time of leaving operation room of A group were less than B group remarkably （P〈0.05）. Conclusion： Sevoflurane inhalation general anaesthesia in emergency caesarean section may curtail the extubation time after operation and the time of leaving operation room, cut down disadvantage influence of Residual neuromuscular blockade to expectant mothers and elevate the safety of anaesthesia.