琥珀酰明胶注射液预防宫内胎儿窘迫和新生儿心脑损害的效果评价

Effect of Succinylated Gelatin Injection on Prevention of Intrauterine Fetal Distress and Neonatal Brain and Myocardial Damage

目的 评价琥珀酰明胶注射液预防宫内胎儿窘迫和新生儿心脑损害的效果。方法 选择2016年7月至2017年12月在沈阳医学院附属中心医院接受剖宫产术的69例产妇为研究对象,根据麻醉方法不同分为对照1组、对照2组、观察组,各23例,全部产妇施行常规蛛网膜下腔麻醉术,对照1组给予蛛网膜下腔麻醉,对照2组进行麻醉穿刺操作前30min内给予高渗盐晶胶复合液静脉滴注,观察组麻醉穿刺操作前30min内给予4%琥珀酰明胶注射液静脉滴注,20min后施行蛛网膜下腔麻醉。比较3组产妇麻醉效果、新生儿娩出后1min及5min的新生儿评分情况,检测脐动脉血乳酸脱氢酶、肌酸激酶同工酶、肌酸激酶、天冬氨酸转氨酶、心肌肌钙蛋白、pH值、动脉血氧分压及动脉血二氧化碳分压水平。结果 3组新生儿动脉血氧分压、动脉血二氧化碳分压、血清乳酸脱氢酶、肌酸激酶同工酶、肌酸激酶和天冬氨酸转氨酶比较,差异有统计学意义(P<0.05);进一步两两比较,观察组和对照2组动脉血氧分压高于对照1组[(37.9±14.9)mmHg(1mmHg=0.133kPa)、(34.7±13.9)mmHg比(28.3±10.1)mmHg],观察组和对照2组动脉血二氧化碳分压低于对照1组[(48.6±6.9)mmHg、(50.3±5.9)mmHg比(57.2±7.9mmHg)](P<0.05);观察组和对照2组的血清乳酸脱氢酶、肌酸激酶同工酶、肌酸激酶、天冬氨酸转氨酶水平均低于对照1组[(278±34)U/L、(299±40)U/L比(513±70)U/L,(28±9)U/L、(33±11)U/L比(58±21)U/L,(236±48)U/L、(279±54)U/L比(578±76)U/L,(37±8)U/L、(42±10)U/L比(54±19)U/L](P<0.05)。3组剖宫产妇女的下肢阻滞情况和麻醉效果比较差异无统计学意义(P>0.05)。Bromage评分3组均为3级。结论 对剖宫产妇女施行蛛网膜下腔麻醉前静脉滴注4%琥珀酰明胶注射液具有较好的预扩容和预防低血压的作用,过敏体质者可选择输注高渗盐晶胶复合液进行预扩容,可以有效预防宫内胎儿窘迫和新生儿心脑损伤。

Objective To evaluate the effect of succinylated gelatin injection in preventing intrauterine fetal distress and neonatal heart and brain damage. Methods A total of 69 delivery women receiving cesarean section in the Central Hospital Affiliated to Shenyang Medical College from Jul.2016 to Dec.2017 were divided into three groups according to different anesthesia methods,control group 1,control group 2 and observation group, with 23 cases in each group.All women underwent routine spinal anesthesia.The control group 1 was given subarachnoid anesthesia.The control group 2 received intravenous infusion of hypertonic saline gel solution 30 min before the implementation of spinal anesthesia .The observation group was given 4% succinylated gelatin injection 30 min prior to the implementation of spinal anesthesia and then subarachnoid anesthesia after 20 min.The anesthetic effects,Apgar scores at 1 min and 5 min following neonatal delivery were compared between the three groups.And the umbilical arterial blood lactate dehydrogenase, phosphocreatine kinase isoenzyme,creatine kinase,aspartate aminotransferase,cardiac troponin,pH,blood oxygen partial pressure and arterial blood carbon dioxide partial pressure levels were measured. Results Blood oxygen partial pressure, arterial blood carbon dioxide partial pressure,lactate dehydrogenase,phosphocreatine kinase isoenzyme,creatine kinase and aspartate aminotransferase were compared between three groups,and the differences were statistically significant( P <0.05).Further comparison showed that PaO 2 of the observation group and control group 2 was higher than that of the control group 1 [(37.9±14.9) mmHg (1 mmHg=0.133 kPa),(34.7±13.9) mmHg vs (28.3± 10.1) mmHg ],and arterial blood carbon dioxide partial pressure was lower than that in the control group 1[( 48.6 ±6.9) mmHg,(50.3± 5.9 ) mmHg vs (57.2±7.9) mmHg]( P <0.05). Umbilical arterial blood lactate dehydrogenase,phosphocreatine kinase isoenzyme,creatine kinase,aspartate aminotransferase levels of the observation group and control group 2 were lower than those of the control group 1[(278±34) U/L,(299±40) U/L vs (513±70) U/L,(28±9) U/L,(33±11) U/L vs (58±21) U/L,(236±48) U/L,(279±54) U/L vs (578±76) U/L,(37±8) U/L,(42±10) U/L vs (54±19) U/L]( P <0.05). There were no significant differences in lower limb block and anesthesia between the three groups ( P >0.05). Bromage score of the three groups were all level 3. Conclusion Implementing intravenous infusion of 4% succinylated gelatin before the subarachnoid anesthesia in cesarean section has good effect of pre-expansion and prevention of hypotension.Allergic patients can choose to infuse hypertonic saline gel solution for pre-expansion,which can effectively prevent intrauterine fetal distress and neonatal cardiac and brain injury.