腰硬联合麻醉与气管插管全身麻醉对剖宫产手术新生儿呼吸的影响

Effects of combined spinal epidural anesthesia and general anesthesia in cesarean section for pediatric ;respiration

目的：比较腰硬联合麻醉与气管插管全身麻醉用于剖宫产手术对新生儿呼吸的影响，探讨剖宫产手术麻醉方式的选择。方法选择行剖宫产产妇140例，采用数字表法随机分为对照组和观察组各70例。对照组采用气管插管全身麻醉，使用丙泊酚、苏芬太尼及顺式阿曲库铵静脉诱导，胎儿取出后再用常规药；观察组采用罗派卡因进行腰硬联合麻醉。记录两组手术时间、切皮至胎儿娩出时间及子宫切开至胎儿娩出时间；胎儿取出后采集脐动脉血样行血气分析，比较两组新生儿出生后1 min、5 min、10 min 时 Apger 评分，第一次呼吸时间以及使用辅助呼吸、胸外按压和药物复苏总例数。结果两组手术时间、切皮至胎儿取出时间及子宫切开至胎儿取出时间差异均无统计学意义（t ＝0．974，P ＝0．332；t ＝0．067，P ＝0．947；t ＝0．803， P ＝0．423）。观察组胎儿取出1 min 后的 Apger 评分[（9．26±0．86）分]明显优于对照组[（8．91±0．75）分]（t ＝－2．566，P ＝0．011），两组5 min、10 min 时 Apger 评分差异均无统计学意义（t ＝－0．533，P ＝0．595；t ＝－0.299，P ＝0.765）；观察组新生儿第一次呼吸时间[（7．17±3．26）s]短于对照组[（21．34±5．75）s]（t ＝17.936，P ＜0.001）。两组新生儿脐动脉血 pH、PaCO2、PaO2差异均无统计学意义（t ＝－0．438，P ＝0．662；t ＝0．102，P ＝0.919；t ＝－0．524，P ＝0．601）。观察组使用辅助呼吸、胸外按压和药物复苏共7例，少于对照组的15例，但差异无统计学意义（χ2＝3．451，P ＝0．063）。结论腰硬联合麻醉对剖宫产手术新生儿呼吸影响更小，可安全地用于剖宫产手术，值得在临床推广应用。

Objective To compare the effect of combined spinal epidural anesthesia and general anesthesia for cesarean section surgery on pediatric respiration,discuss the choice of anesthesia in caesarean operation.Methods 140 cases of maternal line cesarean section were randomly divided into control group and observation group,70 cases in each group.Control group used propofol,sufentanil and cis atracurium intravenous induction,after fetal take out used conventional medicine.The observation group used combined spinal epidural anesthesia with ropivacaine.Recor-ded the operation time,cut skin to fetal childbirth time and uterine incision to fetal childbirth time.Fetal umbilical arterial blood for blood gas analysis,compared the two groups of Apger score at 1min,5min,10min after birth,the first breath of time,and the use of auxiliary breathing,chest compressions and total drug recovery.Results The operation time,cut skin to take time out and uterine incision to fetus fetus in the two groups had no statistical differences（t =0.974,P =0.332;t =0.067,P =0.947;t =0.803,P =0.423）.Apger score at 1min in the observation group [（8.91 ±0.75）min]was better than the control group[（9.26 ±0.86）min]（t =-2.566,P =0.011）,while Apger score between the two groups at 5min,10min had no statistically significant differences（t =-0.533,P =0.595;t =-0.299,P =0.765）.The pediatric first breath[（7.17 ±3.26）s]of the observation group was shorter than the control group[（21.34 ±5.75）s]（t =17.936,P 〈0.001）.pH,PaCO2 ,PaO2 in umbilical artery blood of the two groups had no statistically significant differences（t =-0.438,P =0.662;t =0.102,P =0.919;t =-0.524,P =0.601）.In the observation group used auxiliary breathing,chest compressions and drug recovery in all 7 cases,which was less than 15 cases in the control group,but there was no statistically significant difference （χ2 =3.451,P =0.063）.Conclusion The effect of combined spinal epidural anesthesia for cesarean section in pediatric breathing is smaller,it can be used in a cesarean section safely,and worth popularizing in clinical application.