不同麻醉方法对剖宫产新生儿的影响

Effect of different anesthesia on neonatal cesarean birth

目的:探讨不同麻醉方法对新生儿Apger评分的影响。方法:对10年间不同麻醉下剖宫产出生的新生儿Apger评分进行回顾性分析。结果:10年间剖宫产12 279例,其中单纯硬膜外麻醉占9.48%,单纯腰麻占60.37%,腰硬联合麻醉占28.70%,插管全麻占1.43%;不同麻醉下新生儿窒息发生率分别为0.42%,0.63%,0.34%及70.45%;与其他麻醉方法相比,插管全麻下新生儿窒息率高,有显著性意义,但新生儿死亡率为0%,抢救成功率达100%。结论:腰麻可安全应用于剖宫产麻醉,对新生儿影响小;对于存在椎管内禁忌证及ASAⅢ级以上的患者可选择插管全麻。合理的全麻管理对新生儿抢救是有益的。

Objective： To investigate the effect of different anesthesia on neonatal Apger Score with cesarean birth.Methods： Retrospectively analyzed the Apger Score of the 10-year cesarean birth of the neonatal with different anesthesia.Results： There were 12 279 cases performed cesarean sections in 10 years.Among them,9.48% were with epidural anesthesia,60.37% spinal anesthesia,28.7% epidural and spinal anesthesia,1.43% intubation anesthesia.The incidence of neonatal asphyxia with different anesthesia were 0.42%、0.63%、0.34% and 70.45% respectively.Compared with the other anesthesia methods,the rate of neonatal asphyxia was significantly higher with intubation anesthesia,which was of significant differences.However,the fetal mortality with intubation anesthesia was 0% and survival rate of rescue was 100%.Conclusion： It is safe to use spinal anesthesia in cesarean section,which has less effect on neonatal.While for the patient with contraindication of spinal and epidural anesthesia,or ASA physical status of over class Ⅲ,it is better to choose general anesthesia.Therefore,reasonable general management is beneficial for the neonatal rescue.