双通道靶控丙泊酚、瑞芬太尼麻醉与腰硬联合麻醉对剖宫产出生新生儿Apger评分的影响比较

The influence of dual-channel target controlled propofol and remifentanil anesthesia and combined spinal-epidural anesthesia on Apger score of cesarean birth neonates

目的比较双通道靶控丙泊酚、瑞芬太尼麻醉与腰硬联合麻醉对剖宫产出生新生儿Apger评分的影响。方法将100例ASAⅠ~Ⅱ级,无妊娠并发症和合并症,择期行剖宫产手术的适龄产妇随机分为丙泊酚、瑞芬太尼全凭静脉麻醉组（Ⅰ组）和腰硬联合麻醉组（Ⅱ组）,每组50例。两组在麻醉实施前静脉给予乳酸林格氏液500 ml,术中以乳酸林格氏液500 ml维持,出现血压下降,必要时给予去氧肾上腺素80~120μg,Ⅰ组产妇效应室靶控输注丙泊酚3.3μg/ml、瑞芬太尼6 ng/ml、静注顺式阿曲库铵0.12mg/kg,诱导1 min后插管,术中维持用靶控泵持续输注丙泊酚、瑞芬太尼,维持最初的效应室浓度不变。Ⅱ组产妇采用腰硬联合阻滞麻醉,穿刺间隙选择L3~4,腰麻剂量0.5%罗哌卡因2.5 ml。记录两组患者入室后、开始手术时、断脐时血压、脉搏、SpO2的变化,胎儿出生后1 min时、5 min时、10 min时Apger评分。结果Ⅰ组产妇血压、心率变化较Ⅱ组平稳,Ⅱ组产妇使用去氧肾上腺素的次数多于Ⅰ组,两组比较差异有统计学意义（P〈0.05）;胎儿出生后1 min时、5 min时、10 min时Apger评分两组比较差异无统计学意义（P〉0.05）。结论双通道靶控丙泊酚、瑞芬太尼麻醉较腰硬联合麻醉对循环干扰更小,对胎儿出生时出生后Apger评分的影响无差异。

Objective To compare the influences of dual- channel target- controlled Propofol and Remifentanil anesthesia and combined Spinal- Epidural Anesthesia on Apger scores of newborn after cesarean section. Methods 100 parturient scheduled cesarean section（ ASA I- II,without any associated complications）women were randomly assigned in two groups（ TCI and CSEA,50 in each group）. Parturient of two groups received 500 m L of lactated ringer＇s solution before anesthesia,and another 500 m L for maintenance. 80 ~ 120 μg of phenylephrine were administrated when hypotension being observed. Target concentration of effect compartment of propofol was set to 3. 3ug / m L,and remifentanil was set to 6ng / m L in TCI group. In CSEA group,puncture point was L3- 4,and 0. 5% ropivacaine 2. 5 ml was administrated intrathecally. BP,pulse rate,and Sp O2 were documented at the time point of entering OR,operation beginning,and umbilical cord being cut,and Apger Scores were also documented at 1 min,5 min,and 10 min after birth. Results BP and pulse rate were less fluctuating in TCI group comparing with it in CSEA group（ P〈0. 05）. Phenylephrine was less administrated in TCI group comparing in CSEA group（ P〈0. 05）. There were no statistically differences on Apger Scores at 1min,5 min,and 10 min after birth between the two groups. Conclusions TCI with Propofol and Remifentanil provided more stable hemodynamics than CSEA in cesarean sections,and does not influence Apger Scores after birth.