七氟醚联合瑞芬太尼在剖宫产术中的应用及对产妇血浆炎性细胞因子的影响

Application of sevoflurane combined with remifentanil in cesarean section and its effect on plasma inflammatory cytokines

目的:分析七氟醚联合瑞芬太尼在剖宫产术中的应用效果及对产妇血浆炎性细胞因子的影响。方法:将本院91例剖宫产产妇按随机数字表法分为对照组48例、观察组43例,对照组给予异丙酚联合瑞芬太尼麻醉,观察组给予七氟醚联合瑞芬太尼麻醉。比较两组麻醉恢复情况,血浆炎性细胞因子,血流动力学,新生儿阿氏(Apgar)评分,术中和术后出血量,不良反应。结果:观察组自主呼吸恢复时间、拔管时间、睁眼时间均少于对照组(P<0.05)。术后两组血浆炎性细胞因子水平均较术前上升,但观察组低于对照组(P<0.05);两组血流动力学指标均下降,但观察组变化幅度更小(P<0.05)。两组新生儿Apgar评分、术中及术后24h出血量、不良反应发生情况比较无差异(P>0.05)。结论:七氟醚联合瑞芬太尼在剖宫产麻醉中的应用效果确切,能够抑制血浆炎性细胞因子的释放,对母婴安全性高,可作为剖宫产安全有效的麻醉方式之一。

Objective: To analyze the effect of sevoflurane combined with remifentanil in cesarean section, and to analyze its influence on plasma inflammatory cytokines. Methods: 91 women who wanted cesarean section were divided into control group (48 cases) and observation group (43 cases) according to random number table method. The women in control group were given anesthesia by propofol combined with remifentanil, and the women in observation group were given anesthesia by sevoflurane combined with remifentanil. The situation of anesthetic recovery, plasma inflammatory cytokines levels, hemodynamics value, neonatal Apgar score, volume of intraoperative or postoperative blood loss, and adverse reactions rate of women were compared between the two groups. Results: The time of spontaneous breathing recovery, removal tube, and eye opening of women in observation group were significant shorter than those of women in control group ( P <0.05). The levels of plasma inflammatory cytokines of all women increased after cesarean, and the levels of plasma inflammatory cytokines of women in observation group were significant lower than those of women in control group ( P <0.05). After surgery, the hemodynamic indexes of women in both groups decreased significantly, while that of women in observation group decreased more ( P <0.05). There were no significant different in Apgar score of newborns, volume of intraoperative or postoperative blood loss in 24h after operation, and rate of adverse reaction between the two groups ( P >0.05). Conclusion: Sevoflurane combined with remifentanil used in cesarean section can inhibit the release of inflammatory cytokines, improve security of mothers and babies, so it can be used as one of safe and effective anesthetic methods for cesarean section.