预防新生儿窒息产妇术前纳洛酮给药方式探讨

Exploration on maternal preoperative administrative patterns of naloxone for preventing neonatal asphyxia

目的:观察胎儿窘迫产妇术前不同方式给予纳洛酮对剖宫产新生儿的影响,选择一种预防新生儿窒息更有效的给药方式。方法:选择满足手术条件的胎儿窘迫产妇499例,随机分为两组。观察组(n=216)术前4～6 h静脉滴入0.1 mg/mg纳洛酮,间隔0.5～1 h重复1～2次;治疗组(n=233)术前4～6 h泵注纳洛酮8 mg至胎儿剖出,速度为8 ml/h。新生儿剖出未呼吸前夹脐带两端,抽取脐动脉血3 ml做血气分析。同时对新生儿进行即刻Apgar评分,两组Apgar评分8～10分、4～7分、0～3分各段随机采集10例新生儿脐静脉血4 ml,测血浆β-EP水平。结果:两组新生儿剖出即刻正常和轻度窒息率无统计学差异(P>0.05),重度窒息新生儿数观察组比治疗组高(χ2=6.280,P=0.013)。治疗组新生儿酸中毒症状轻,脐动脉血气pH、PaCO2、PaO2、HCO3-值优于观察组(P<0.05)。正常和轻度窒息新生儿脐静脉血β-EP水平两组无统计学差异(P>0.05),重度窒息新生儿脐静脉血β-EP水平观察组明显高于治疗组(P<0.05)。随着新生儿窒息程度减轻,脐静脉血β-EP水平降低。两种方式给药后,显效新生儿数治疗组明显高于观察组(χ2=5.402,P=0.023);有效新生儿数两组无统计学差异(χ2=3.789,P=0.064),无效率观察组比治疗组高(χ2=6.230,P=0.018)。结论:胎儿窘迫产妇术前4～6 h纳洛酮持续泵注比多次静脉滴入更能有效预防新生儿窒息。

Objective： To observe the effect of different administrative patterns of naloxone before cesarean section among pregnant women with fetal distress on neonates, and choose a more effective administrative pattern to prevent neonatal asphyxia. Methods： A total of 499 pregnant women with fetal distress meeting surgical criteria were randomly divided into two groups： 216 patients in observation group were treated with intravenous drip of naloxone （0. 1 mg/mg） at 4 - 6 hours before cesarean section, the treatment was repeated for 1 - 2 times every 0. 5 - 1 hour; 233 patients in treatment group were treated with pump injection of naloxone （8 mg） at 4 -6 hours before cesarean section until delivery, the speed was 8 ml/h. Both ends of umbilical cords of neonates after birth were clipped before respiration, 3 ml um- bilical artery blood was abstracted for blood gas analysis. Apgar score was conducted immediately, 4 ml umbilical venous blood samples of 10 neonates whose Apgar scores were 8 - 10, 4 - 7, and 0 - 3 were randomly collected, plasma [3 - EP levels were detected. Results： There was no statistically significant difference in the incidence rate of mild asphyxia at birth between the two groups （P 〉 0. 05 ）, the number of neonates with severe asphyxia in observation group was statistically significantly higher than that in treatment group （X2 = 6. 280, P = 0. 013） . The symptoms of neonatal acidosis in treatment group were mild, the levels of pH value, PaCO2, PaO2, and HCO3 - detected by blood gas analysis were superior to those in observation group （ P 〈 0. 05 ） . There was no statistically significant difference in β - EP level in umbilical venous blood between neonates without asphyxia and neonates with mild asphyxia （P 〉 0. 05 ） , the level of β - EP in umbilical ve- nous blood of neonates with severe asphyxia in observation group was statistically significantly higher than that in treatment group （P 〈 0. 05） . The level of β - EP in umbilical venous blood decreased with alleviation of degree of neonatal asphyxia. The obviously effective rate in treatment group was statistically significantly higher than that in observation group （X2 = 5. 402, P = 0. 023 ） ; there was no statistically signif- icant difference in the effective rate between the two groups （X2 = 3. 789, P = 0. 064 ） , the ineffective rate in observation group was statisti- cally significantly higher than that in treatment group （X2 = 6. 230, P = 0. 018 ） . Conclusion： Continuous pump injection of naloxone at 4 -6 hours before cesarean section in pregnant women with fetal distress can more effectively prevent neonatal asphyxia compared with intra- venous drip of naloxone for many times.