瑞芬太尼用于妊娠高血压综合征患者剖宫产术中麻醉的安全性及对神经肽的影响

Safety Evaluation of Remifentanil for Cesarean Section in Patients with Pregnancy-induced Hypertension

目的评价瑞芬太尼用于妊娠高血压综合征患者剖宫产术中麻醉的安全性及对神经肽(NPY)的影响。方法选取2014年2月~2017年2月在某院行剖宫产手术的妊娠高血压综合征患者90例,随机分为观察组(瑞芬太尼组)及对照组(芬太尼组)各45例,分别检测患者麻醉诱导前(T1)、插管前(T2)、插管后(T3)、切皮时(T4)、胎儿娩出后(T5)的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_2)及NPY水平,并观察胎儿Apgar评分及血气分析情况。结果对照组在T3、T4时HR、MAP水平明显高于观察组,差异有统计学意义(P<0.05);组内比较,对照组在T3、T4时HR、MAP水平明显高于其他时间点,差异有统计学意义(P<0.05);观察组1 min Apgar评分明显高于对照组,差异有统计学意义(P<0.05);与组内基础值比较,观察组在胎儿娩出后(T5)NPY水平明显降低,对照组在T3、T4时NPY水平明显升高,T5时NPY水平明显降低(P均<0.05);对照组在T3、T4时NPY水平较观察组明显升高(P<0.05)。结论在妊娠高血压综合征患者行剖宫产术中麻醉时,用瑞芬太尼能改善NPY水平,对母婴有较高的安全性。

OBJECTIVE To evaluate the safety of remifentanil for cesarean section in patients with pregnancy-induced hypertension syndrome and the effect of remifentanil on neuropeptide（ NPY）. METHODS 90 cases of pregnancy induced hypertension syndrome were selected from February 2014 to February 2017 in a hospital,45 cases were randomly divided into observation group（ remifentanilgroup） and control group（ fentanyl group）. The patients were measured before induction of anesthesia（ T1）,before intubation（ T2）,after intubation（ T3）,skin incision（ T4） after delivery of fetus（ T5）,heart rate（ HR）,mean arterial pressure（ MAP）,oxygen saturation（ SpO_2） and NPY level,fetal Apgar score and blood gas analysis were observed. RESULTS The level of HR,MAP in the control group was significantly higher than that in the observation group at T3 and T4,the difference was statistically significant（ P0.05）.Compared with the control group,the level of HR,MAP in the control group was significantly higher than that in the control group at T3 and T4,the difference was statistically significant（ P 0. 05）. The 1-minute Apgar score in the observation group was significantly higher than that in the control group,the difference was statistically significant（ P 0. 05）. Compared with the underlying values in the group,after fetal removal（ T5）,the level of NPY in the observation group was significantly decreased,the level of NPY in the control group was significantly higher at T3 and T4,the level of NPY was obviously decreased at T5（ P0.05）.The level of NPY in the control group was significantly higher than that in the observation group at T3 and T4（ P0.05）. CONCLUSION In patients with pregnancy-induced hypertension undergoing caesarean section anesthesia,remifentanil can improve NPY level,it has high safety to mother and child.