三种静脉复合全身麻醉在剖腹产中的比较

Comparison of Compound Intravenous General Anesthesia among Three Therapies in Caesarean Operation

目的：探讨三种静脉复合全身麻醉方法对产妇和新生儿的影响。方法：120例足月妊娠产妇,ASA评分（1~2）级,随机分为3组（n=40）,丙泊酚组（A组）、丙泊酚复合瑞芬太尼组（B组）、丙泊酚复合氯胺酮组（C组）,麻醉诱导后气管插管,机械通气。分别观察各组产妇麻醉诱导前、诱导后、切皮时心率（HR）、平均动脉压（MAP）、血氧饱和度（SPO2）变化,术中知晓发生率,新生儿1分钟、5分钟Apgar评分、新生儿第一次呼吸时间、以及使用辅助呼吸、胸外按压和药物复苏例数。结果：A组产妇HR和MAP麻醉诱导前、后和切皮时变化明显,组内比较差异有显著性（P〈0.05）,A、B组产妇麻醉诱导后低血压发生率明显高于C组（P〈0.05）。新生儿第一次呼吸时间A组和B组长于C组（P〈0.05）,使用辅助呼吸例数和胸外按压例数A、B组多于C组（P〈0.05）。结论：丙泊酚复合氯胺酮对产妇循环影响小,对新生儿影响轻微,是一种比较理想的麻醉方法。

Objective： To observe effects of three therapies of compound intravenous anesthesia on maternal and neonatal in caesarean operation. Methods： 120 full term pregnancy women with ASA（ 1 - 2） grade were divided into randomLy the three groups of 40 each： propofol group（ A group）,fentanyl plus propofol group（ B group） and propofol plus ketamine group（ C group）. Endotracheal intubation and mechanical ventilation were conducted after anesthesia induction in three groups,and observing the changes of HR、MAP,SPO2,rate of awareness and skin incision time before and after induction; neonatal breathing for the first time,assisted breath and neonatal Apgar score were recorded too. Results： Intra- group comparison： HR and MAP had a significant change（ P〈0. 05） at skin incision,before and after induction in A group; and lower BP was in A and B group as compared with C group（ P〈0. 05） after anesthesia induction. The breathing for the first time and assisted breath were more available for neonatal in A and B group than that in C group（ P〈0. 05）. Conclusions： The propofol plus ketamine general anesthesia therapy is more efficiency and light of influence for caesarean operation in clinic.