丙泊酚复合瑞芬太尼或氯胺酮用于剖宫产全麻的临床观察

The clinical investigation on the application of propofol combined with remifentanil or ketamine in general anesthesia for caesarean section

目的观察比较丙泊酚复合小剂量瑞芬太尼或氯胺酮用于剖宫产全麻的麻醉效果和对新生儿的影响。方法选取2016年1月—2017年12月本院收治的胎儿正常,ASAⅠ～Ⅱ级需全麻剖宫产的产妇100例,随机分为R组和K组两组,每组各50例。R组用小剂量瑞芬太尼复合丙泊酚,K组用小剂量氯胺酮复合丙泊酚,均用琥珀胆碱肌松,静注麻醉诱导。观察在麻醉前、切皮和取胎时各组的心率和MAP;根据麻醉诱导到胎儿娩出时间≤5 min或>5 min各组均被分为两个亚组:R1和R2、K1和K2组,观察各亚组1 min、5 min新生儿Apgar评分。结果所有新生儿Apgar评分均≥8分,R2组1 min新生儿Apgar评分明显低于5 min和其他各亚组的1 min、5 min新生儿Apgar评分(P<0.05)。结论小剂量瑞芬太尼复合丙泊酚用于剖宫产全麻麻醉效果满意,但随着对胎儿的暴露时间延长,可对新生儿产生短暂轻度抑制;小剂量氯胺酮复合丙泊酚麻醉效果满意,对新生儿无明显抑制,是较理想的剖宫产全麻方法。

Objective To investigate the efficiency of propofol combined with remifentanil or ketamine applied in the general anesthesia for caesarean section and its effects on neonates.Methods 100 puerpera,ASA between Ⅰ to Ⅱ level and with normal fetus,needed cesarean section under general anesthesia were selected and randomly divided into R group and K group,50 cases in each group.Propofol combined with low dose of remifentanil was applied in the puerpera of the R group,and propofol combined with low dose of ketamine was applied in the puerpera of the K group.Anectine was used for muscle relaxation,intravenous injection for anesthesia induction in all groups.The heart rate and MAP were observed at the time before anesthesia,skin incision and the fetus were taken out.According to the duration from anesthesia induce to the fetal delivery whether less than 5 min or more than 5 min,all groups were divided into two subgroups:R1 and R2,K1 and K2.And Apgar scores of neonate at the 1 st min,5 th min in all subgroups were also observed.Results Apgar scores of all newborns were not less than 8.The 1 min neonatal Apgar scores in R2 was significantly lower than that at 5 th min,and the 1 min neonatal Apgar scores also less than the scores in other respective subgroups at 1 st min and5 th min(P<0.05).Conclusions For cesarean section,the effect of the small dose remifentanil combined propofol is satisfactory,but as prolonged exposure to the fetus,temporary small inhibition of the newborn may produce.The effect of low dose ketamine combined propofol is satisfactory without inhibition of the newborn,so it is an ideal general anesthesia method for cesarean section.