二次剖宫产术辅用瑞芬太尼对产妇和新生儿影响的观察

Effect of remifentanil as adjuvant on parturient women and neonates in second cesarean section

目的探讨在持续硬膜外麻醉下行二次剖宫产术时,靶控输注瑞芬太尼对产妇和新生儿的影响。方法择期行二次剖宫产术产妇80例,ASAⅠ～Ⅱ级,随机分成两组(n=40),即瑞芬太尼组(R组)和对照组(C组)。R组以血浆靶浓度1.5μg/L靶控输注瑞芬太尼,C组输注0.9%氯化钠注射液,血样采集完毕时停止输注。记录产妇入室平静5min(T0)、切皮时(T1)、胎儿娩出时(T2)、子宫缝合时(T3)和关腹时(T4)的MAP、HR、RR、Ramsay镇静评分、胎心率(FHR)、新生儿1min与5min的Apgar评分、1h与24h新生儿神经行为评分(NBNA)和产妇不良反应的情况。胎儿娩出后3min取脐动脉、脐静脉血各1ml行血气分析。结果两组产妇各时点的MAP、HR、RR比较,差异均无统计意义(P均>0.05)。R组产妇有32例达到满意镇静(Ramsay2级和3级),而C组为16例,两组间的差异有统计学意义(χ2=13.33,P<0.05);在抑制牵拉反应方面,R组产妇有14例可以达到0级,相比于C组的6例,差异有统计学意义(χ2=4.27,P<0.05)。两组产妇的新生儿脐静脉和脐动脉的血pH、PaO2、PaCO2比较,差异均无统计学意义(P均>0.05)。两组产妇FHR、新生儿体重、NBNA评分均在正常范围内,两组新生儿1minApgar评分结果均≥8分,5min评分均为10分;R组部分产妇诉切皮前有不适,其中有5例有轻微眩晕、头痛1例,两组均未发生低血压和心动过缓。结论以血浆靶浓度1.5μg/L靶控输注瑞芬太尼辅助硬膜外麻醉行二次剖宫产术时,有良好的辅助镇痛作用,对新生儿无不良影响。

Objective To investigate effects of remifentanil as adjuvant on parturient women and neonates after the second cesarean section with continuous epidural anesthesia（CEA）.Methods A total of 80 parturients were randomly assigned to control group（group C,n=40） and remifentanil group（group R,n=40）.Group R received target controlled infusion of remifentanil at a target plasma concentration of 1.5 μg/L.In group C,equal volume of normal saline was infused.MAP,HR and RR in time of mater calm 5 min（T0）,cutting skin（T1）,fetal childbirth（T2）,uterine suture（T3） and closing abdomen（T4）,and Ramsay sedation scores were recorded.Fetal heart rate（FHR）,Apgar score at l min and 5 min after delivery and neonatal behavioral neurological assessment（NBNA） at 1 hour and 24 hours after delivery were also recorded.Adverse effects including hypotension,sinus bradycardia,respiratory depression,nausea and vomiting were recorded.Umbilical arterial（UA）and venous（UV）blood samples were obtained within 3 min after delivery for blood gas analysis.Results There were no significant differences in MAP,HR,RR at T0～T4（P0.05）.In group R,32 parturients could get satisfied sedation（Ramsay grade 2～3）,and comparing with 16 in group C,the difference was significant（χ2 =13.33,P0.05）;In inhibitory traction response,14 parturients in group R could get grade 0,comparing with 6 in group C,the difference was significant（χ2=4.27,P0.05）.In blood gas analysis,pH,PaO2,PaCO2 of umbilical arterial and venous were of no significant differences（P0.05）.There were no significant differences in FHR,body weight of the newborn and NBNA scores between the two groups.Five parturients in group R felt a little dizzy,1 parturient had headache.There were no hypotension and sinus bradycardia cases.Conclusions Remifentanil given by TCI at a target plasma concentration of 1.5 μg/L on parturients undergoing the second planned cesarean section has good analgesia effect and no adverse effects on the newborn.