全身麻醉对脐血乳酸、S100B、SOD、MDA以及胎盘体视学的影响

Effects of general anesthesia on lactic acid,S100B,SOD and MDA in umbilical cord blood and placenta stereology

目的:通过研究全身麻醉(GA)与腰硬联合麻醉(SA)对脐带血乳酸、S100B、超氧化物歧化酶(SOD)活性、丙二醛(MDA)水平以及胎盘体视学的影响,探讨全身麻醉下行剖宫产的安全性以及对新生儿影响。方法:选择50例行择期剖宫产术的单胎足月初产妇,分GA组和SA组,2组均为25例。记录术中产妇的血压、心率以及新生儿1 min及5 min的Apgar评分,比较2组脐动脉血乳酸、血清S100B浓度、SOD与MDA水平,并取胎盘组织对绒毛微血管进行体视学研究。结果:2组术中血流动力学参数、新生儿1 min及5 min的Apgar评分、脐动脉血p H、红细胞压积(Hct)、血红蛋白(Hb)浓度、脐带血血清S100B浓度和胎盘绒毛微血管的长度密度,差异均无统计学意义(P>0.05),GA组脐血乳酸浓度和SOD活性较SA组降低,差异有统计学意义(P<0.01);GA组脐带血MDA含量和胎盘绒毛微血管体积密度较SA组增加,差异有统计学意义(P<0.01)。结论:全身麻醉对剖宫产新生儿安全无明显影响;虽然脐血乳酸以及胎盘绒毛体视学观察结果显示,全身麻醉下行剖宫产对新生儿的氧供有利,但是氧化-抗氧化指标结果显示,全身麻醉有对新生儿产生氧自由基损伤的可能。

AIM： To explore the safety of anesthesia for neonates by studying the effects of general anesthesia（ GA） and spinal-epidural anesthesia（ SA） on the levels of lactic acid,S100 B,superoxide dismutase（ SOD） and malondialdehyde（ MDA） in the umbilical cord blood and placental stereological changes. METHODS： The singleton,term pregnancy of 50 patients for elective cesarean section were assigned to 2 groups： GA group and SA group,with 25 patients in each group. Blood pressure（ BP） and heart rate（ HR） of the parturient women were monitored and recorded at 6 time points. The Apgar score was calculated at 1 min and 5 min after birth. The gas analysis of the umbilical artery blood,S100 B protein concentration,blood lactic acid,SOD and MDA were also measured. Stereological evaluation of the vascular adaptations in the human placental villous capillary was performed. RESULTS： BP,HR,Apgar scores,gas analysis,the p H value of the umbilical artery blood,the serum concentrations of S100 B protein and the length density of villous capillaries had no significant change between the 2 groups（ P〉0. 05）. The levels of blood lactic acid and SOD in GA group were significantly lower than those in SA group（ P〈0. 01）. MDA content and volume density of villous capillaries in GA group were significantly higher than those in SA group（ P〈0. 01）. CONCLUSION： General anesthesia for cesarean section was safety for neonates. However,as indicated by the oxidation index,general anesthesia may have some harmful effect on the neonates by oxygen free radicals.