剖宫产术中应用氨茶碱对新生儿窒息的预防作用研究

Clinical Study on Preventive Effect of Aminophylline against Neonatal Asphyxia during Cesarean Section

目的:研究剖宫产术中产妇应用小剂量的氨茶碱对新生儿窒息的预防作用。方法:将80例拟行剖宫产术的产妇随机均分为对照组和氨茶碱组。氨茶碱组产妇于切皮时静脉注射氨茶碱注射液2mg/kg,对照组常规进行手术,分别记录两组静脉注射氨茶碱、麻醉诱导及子宫切开胎儿娩出的时间,新生儿出现第1次呼吸及哭叫的时间,并监测血药浓度,进行血气分析,记录胎儿呼吸运动、胎心率及新生儿Apgar评分。结果:氨茶碱组新生儿均未发生新生儿窒息,对照组有12例发生新生儿窒息,且有1例发生新生儿呼吸窘迫综合征。两组新生儿体质量、麻醉诱导至娩出时间经统计学处理,差异无统计学意义(P>0.05)。胎儿娩出后第1次呼吸及哭叫出现的时间、新生儿Apgar评分和血气分析比较,差异均有统计学意义(P<0.05),氨茶碱组显著优于对照组。宫内窘迫的胎儿娩出后Apgar评分与脐血茶碱浓度呈正相关(r=0.910,P<0.01)。氨茶碱组新生儿呼吸运动和胎心率用药前、后比较均未见异常。两组研究中未见不良反应发生。结论:剖宫产术中小剂量注射氨茶碱可有效预防新生儿窒息。

OBJECTIVE： To research preventive effect of small dose of aminophylline against neonatal asphyxia during cesarean section. METHODS： 80 patients undergoing cesarean section were randomized into control group and aminophylline group. Aminophylline group was injected with Aminophylline injection 2 mg/kg intravenously during skin incision; the time of intravenous injection of aminophylline, induction of anesthesia, hysterotomy and fetal disengagement, the time of the first breath and crying after delivery were recorded in 2 groups; the blood concentration, fetal breathing movements and fetal heart rate, Apgar score were also recorded. RESULTS： No neonatal asphyxia was found in aminophylline group, and 12 cases of control group suffered from neona- tal asphyxia and there was a case of neonatal distress syndrome. There was no statistical significance in neonatal body weight, time of anesthesia induction until delivery （P〉0.05）. There were statistical significance in the time of the first breath and crying after delivery, Apgar score and blood gas analysis （P〈0.05）, and those index of aminophylline group were better than control group. Apgar score was positively associated with the concentration of theophylline in umbilical cord blood in fetal distress cases after delivery （r=0.910, P〈0.01）. The neonatal respiratory movement and fetal heart rate of aminophylline group showed no abnormalities before and after medication. No ADR was found in 2 groups. CONCLUSION： Small-dose injection of aminophylline may be effective in preventing neonatal asphyxia during cesarean section.