全凭静脉麻醉对剖宫产术中孕妇血流动力学和新生儿Apgar评分及血气分析的影响

Effects of total intravenous anesthesia on hemodynamics in pregnant women during cesarean section and Apgar score and blood gas analysis in neonatal

目的:观察全凭静脉麻醉方式对剖宫产术中孕妇血流动力学和新生儿Apgar评分及血气分析的影响。方法:选择行剖宫产术的100例产妇作为研究对象,按照随机数表法分为对照组和观察组各50例,对照组产妇采用静脉吸入复合麻醉,观察组产妇采用全凭静脉麻醉,监测记录产妇麻醉诱导前(T0)、手术开始时(T1)、分娩时(T2)及分娩后1 h(T3)的血流动力学指标,包括心率(HR)、平均动脉压(MAP)和血氧饱和度(SpO_2)。胎儿娩出后立即取脐动脉进行血气分析,于分娩后1 min、5 min,对新生儿进行Apgar评分。结果:两组产妇T1、T2、T3期MAP均低于组内T0期,T1、T2、T3期HR均高于T0期,差异有统计学意义(P<0.05);观察组T1、T2、T3期MAP高于同期对照组,T1、T2、T3期HR均低于同期对照组,差异有统计学意义(P<0.05);两组产妇各时期SpO_2无明显变化(P>0.05);两组新生儿分娩后5 min的Apgar评分高于分娩后1min,差异有统计学意义(P<0.05);观察组分娩后1 min、分娩后5 min的Apgar评分与同期对照组比较差异无统计学意义(P>0.05);两组新生儿血气分析指标pH、PO_2和PCO_2差异无统计学意义(P>0.05)。结论:全凭静脉麻醉方式对剖宫产术中孕妇血流动力学的影响优于静脉吸入复合麻醉方式,全凭静脉麻醉方式和静脉吸入复合麻醉方式均对新生儿Apgar评分及血气分析无明显影响。

Objective： To study effects of total intravenous anesthesia on hemodynamics in pregnant women during cesarean section and Apgar score and blood gas analysis in neonatal. Methods： 100 parturients undergoing caesarean section were collected and were divided into the control group and observation group according to the random number table method,50 cases in each. The control group was given intravenous inhalation combined anesthesia,while the observation group was given total intravenous anesthesia. The hemodynamic parameters,including heart rate（ HR）,mean arterial pressure（ MAP） and blood oxygen saturation（ SpO2）,were recorded before the anesthesia induction（ T0）,at the beginning of surgery（ T1）,at delivery（ T2） and 1 h after delivery（ T3）. The blood gas analysis of umbilical artery was performed after delivery of the fetus,and the Apgar scores were assessed 1 min and 5 min after delivery. Results： The MAPs at T1,T2 and T3 in the two groups were lower than those at T0,the HRs were higher at T1,T2 and T3 were higher than those at T0,and the differences were statistically significant（ P〈0.05）. The MAPs at T1,T2 and T3 of the observation group were higher than those of the control group,the HRs were lower were higher than those of the control group,and the differences were statistically significant（ P〈0.05）. There was no significant change in SpO2 between the two groups（ P〉0.05）. The Apgar score 5 min after delivery in the two groups of the neonates were higher than those 1 min after delivery（ P〈0.05）. There were no difference in the Apgar scores 1 min and 5 min after delivery between the two groups（ P〉0.05）. Further,there were no difference in the blood pH,PO2 and PCO2 between the two groups（ P〉0.05）. Conclusions： The effects of total intravenous anesthesia on hemodynamics in the pregnant women during cesarean section are superior to the intravenous inhalation combined anesthesia. Moreover,both have no significant effects on the fetal Apgar score and blood gas analysis.