丙泊酚复合雷米芬太尼全身麻醉对剖宫产术中新生儿氧摄取率的影响

Effect of general anesthesia with propofol and remifentanil on ERO_2 of neonates during Cesarean section

目的比较不同麻醉方法用于剖宫产手术中对新生儿氧摄取率(ERO_2)的影响。方法选择40例行子宫下段剖宫产手术的足月产妇,有椎管内麻醉禁忌证者纳入丙泊酚复合雷米芬太尼全身麻醉组(GA组,20例),无椎管内麻醉禁忌证者纳入硬膜外麻醉组(EA组,20例)。比较两组麻醉开始至胎儿娩出时间(I-D)、子宫切开至胎儿娩出时间(U-D)、新生儿娩出后的脐动静脉血气分析值、ERO_2、Apgar评分和新生儿神经行为学(NBNA)评分。结果 EA组I-D长于GA组(P<0.05),两组U-D、新生儿脐动静脉血pH值、PO_2、PCO_2、SpO_2、Hb含量及ERO_2均无统计学差异(P>0.05)。GA组新生儿1-min Apgar评分低于EA组(P<0.05),两组5-min Apgar评分无统计学差异(P>0.05)。所有新生儿24h的NBNA评分大于35分。结论丙泊酚复合雷米芬太尼全身麻醉用于剖宫产手术对新生儿的ERO_2影响较小,但应预防新生儿一过性呼吸抑制。

Objective To compare the effect of different anesthesia methods on oxygen extraction rate（ERO_2）of neonates during Cesarean section.Methods Forty full-term puerperants underwent Cesarean section were divided into two groups of GA（with contraindication for spinal puncture,20cases）and EA（without contraindication for spinal puncture,20cases）.Group GA received general anesthesia with combined use of propofol and remifentanil and group EA received epidural anesthesia.The time from the start of anesthesia to neonatal delivery（I-D）and that from uterus opening to neonatal delivery（U-D）,the values of umbilical arterial and venous blood gas analysis,neonates ERO_2,Apgar scores and neonatal behavioral neurological assessment（NBNA）scores were compared between two groups.Results I-D time was longer in group EA than that in group GA（P0.05）.There were no significant differences in U-D time,ERO_2,and pH value,PO_2,PCO_2,SpO_2,hemoglobin concentration of umbilical arterial and venous blood between two groups（P0.05）.The 1-min Apgar score of neonates was higher in group EA than that in group GA,while there was no significant difference in 5-min Apgar score between two groups（P0.05）.The NBNA scores of the neonates at 24 hours after delivery were more than 35 points in both groups.Conclusion General anesthesia with combined use of propofol and remifentanil in Cesarean section has little effect on ERO_2 of the neonates,but attention should be paid to transient respiratory depression of neonates.