瑞芬太尼在剖宫产全麻中的临床应用

THE CLINICAL APPLICATION OF REMIFENTANIL IN GENERAL ANESTHESIA AT CESAREAN SECTION

目的 比较丙泊酚和丙泊酚联合瑞芬太尼在剖宫产全麻诱导中麻醉的效果,以及二种诱导方法对剖宫产胎儿Apgar评分的影响。方法 选择ASA（美国麻醉医师协会）分级Ⅰ~Ⅱ级,足月妊娠伴血小板减少症,拟全麻下行剖宫产术产妇40例,随机分成二组（n=20）Ⅰ组：丙泊酚组,Ⅱ组：丙泊酚联合瑞芬太尼组,分别记录诱导前、切皮前、切皮时、切皮后1,2,3min心率（HR）、平均动脉血压（MAP）、血氧饱和度（SpO2）,胎儿娩出1,2,3,5,10min的Apgar评分。结果 二组患者的HR、MAP在切皮前、切皮时、切皮后1,2,3min均有明显改变（P〈0.05）,差异有统计学意义,胎儿娩出1,2,3,5,10min的Apgar评分无明显改变,差异无统计学意义（P〉0.05）。结论 瑞芬太尼联合丙泊酚诱导在剖宫产全麻中麻醉更平稳,更安全,值得临床实践。

Objective To compare the anesthesia induction effect between Propofolum and Propofolum combination with Remifentanil at cesarean section,and to study the influence of this two inducing methods on the fetal＇s Apgar scores.Methods A total of 40 patients with uterogestation with ASAⅠ~Ⅱlevel,who had to be operated cesarean section in general anesthesia because of complicating thrombocytopenia,were randomly divided into group I（Propofolum group,n=20）and group Ⅱ（Propofolum combination with Remifentanil group,n=20）.The heart rate（HR）,mean arterial blood pressure（MAP）and oxygen saturation（SpO2）before induction,before skin incision,skin incision were recorded respectively at one minute,two minutes,three minutes after incision in the two groups.Then the fetal＇s Apgar scores were recorded respectively when fetal disengagement one minute,two minutes,three minutes,five minutes,ten minutes.Results The heart rate（HR）,mean arterial blood pressure（MAP）before skin incision,skin incision at one minute,two minutes,three minutes after incision all had statistical difference（P〈0.05）between the two groups,but the Apgar scores had no statistical difference when fetal disengagement at one minute,two minutes,three minutes,five minutes,ten minutes（P〉0.05）.Conclusion The anesthesia induction effect of Propofolum combination with Remifentanil at cesarean section is more stable,more secure than Propofolum,and it is worthy of clinical practice.