腹横肌平面阻滞复合七氟醚全麻对产妇及新生儿的影响

Effects of transverse abdominal plane block combined with sevoflurane general anesthesia on parturients and newborns

目的观察腹横肌平面阻滞(TAPB)复合七氟醚全麻对剖宫产产妇术中血流动力学及新生儿脐动脉血气分析的影响。方法选取2017年1~6月我院ASA分级Ⅰ或Ⅱ级、单活胎足月妊娠的剖宫产产妇60例,分为TAPB复合七氟醚全麻组(T组,n=30)和腰硬联合麻醉组(C组,n=30)。T组产妇采用双侧TAPB后,七氟醚吸入全麻诱导后置入喉罩;C组产妇采用腰硬联合麻醉。记录产妇的麻醉前(T1)、麻醉后2 min(T2)、切皮时(T3)、新生儿出生后5 min(T4)、手术结束(T5)各时刻产妇心率(HR)、平均动脉压(MAP)的变化,记录手术持续时间、麻黄碱用量、术中低血压,记录新生儿出生时的脐动脉血气分析结果,新生儿的Apgar评分。结果组内比较,T组术中HR、MAP变化与麻醉前比较差异无统计学意义(P>0.05);C组产妇麻醉后HR升高,MAP下降,胎儿娩出后MAP升高(P<0.05);与C组比较,T组产妇T2时点HR低于C组,T2、T3时点MAP高于C组(P<0.05);T组测得的新生儿脐动脉血气分析pH值、动脉血氧分压(PaO 2)高于C组(P<0.05);T组测得的新生儿脐动脉血二氧化碳分压(PaCO 2)低于C组(P<0.05);2组新生儿Apgar评分差异无统计学意义(P>0.05)。结论TAPB复合七氟醚全麻对剖宫产产妇血流动力学稳定、新生儿的血气分析结果更优。

Objective To observe the effect of transverse abdominal plane block(TAPB)combined with sevoflurane general anesthesia on hemodynamics in parturients during cesarean section and umbilical arterial blood gas analysis in neonates.Methods Sixty American Society of Anesthesiologists physical statusⅠorⅡfull-term pregnant women,with cesarean delivery of single live fetus,in Shunde Hospital of Southern Medical University from January to June 2017 were selected and divided into two groups(n=30 each):group T(TAPB combined with sevoflurane)and group C(spinal and epidural anesthesia group).Parturients in group Treceived bilateral TAPB.Laryngeal mask airway(LMA)was inserted after induction of anesthesia with inhalation of sevoflurane.Parturients in group C received spinal and epidural anesthesia.Mean blood pressure(MAP),heart rate(HR)were recorded at before anesthesia(T1),2 min after anesthesia(T2),skin incision(T3),5 min after delivery(T4),end of surgery(T5).Operation time,dosage of ephedrine,intraoperative hypotension and umbilical artery blood gas analysis in neonates and neonatal Apgar score were also recorded.Results There was no significant difference in group Tin MAP and HR through the operation(P>0.05).In group C,HR increased and MAP decreased after spinal and epidural anesthesia(P<0.05).Compared with group C,HR was lower at T2,and MAP was higher at T2,T3 in group T(P<0.05).Compared with group C,pH and PaO 2 of umbilical arterial blood were higher in group T(P<0.05),while the value of PaCO 2 was lower(P<0.05).There was no significant difference in Apgar score between the two groups(P>0.05).Conclusion TAPB combined with sevoflurane general anesthesia can improve hemodynamics stability in parturients and results of umbilical arterial blood gas analysis in neonates during cesarean section.