瑞芬太尼复合七氟醚全麻对初产妇剖宫产术中血压及心率变化的影响

Effects of General Anesthesia with Remifentanil Combined with Sevoflurane on Changes of Blood Pressure and Heart Rate during Cesarean Section in Primiparas

目的:观察瑞芬太尼复合七氟醚全麻对初产妇剖宫产术中血压及心率变化的影响。方法:选取2018年1月-2019年6月笔者所在医院收治的初产妇94例,均行剖宫产术。按随机数字表法分为观察组与对照组,每组47例。对照组术中行腰硬联合麻醉,观察组行瑞芬太尼复合七氟醚全麻。比较两组不同时间点新生儿阿氏(Apgar)评分、血流动力学指标[平均动脉压(MAP)、心率(HR)]及手术前后炎性因子[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]变化情况。结果:两组不同时间点Apgar评分比较,差异均无统计学意义(P>0.05);给药10、30 min及手术结束时,观察组MAP、HR均低于对照组(P<0.05);观察组术后血清TNF-α、IL-6水平均低于对照组(P<0.05)。结论:瑞芬太尼复合七氟醚全麻在初产妇剖宫产术中效果确切,能有效维持血流动力学稳定,对新生儿影响小,并能抑制炎性因子释放,确保母婴安全,可作为剖宫产术中安全有效的麻醉方式之一。

Objective:To observe the effects of general anesthesia with Remifentanil combined with Sevoflurane on changes of blood pressure and heart rate during cesarean section in primiparas.Method:A total of 94 primiparas admitted to our hospital from January 2018 to June 2019 were selected and all received cesarean section.They were divided into the observation group and the control group by random number table method,with 47 cases in each group.The control group received combined lumbar and epidural anesthesia,and the observation group received general anesthesia with Remifentanil combined with Sevoflurane.The changes of Apgar scores at different time points,hemodynamics indexes [mean arterial pressure (MAP),heart rate (HR)],inflammatory cytokines [tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6)] before and after surgery were compared between the two groups.Result:The Apgar scores at different time points were compared between the two groups,and the differences were not statistically significant (P>0.05).At 10 and 30 min of administration and at the end of surgery,MAP and HR in the observation group were lower than those of the control group (P<0.05).After surgery,the levels of serum TNF-α and IL-6 in the observation group were lower than those of the control group (P<0.05).Conclusion:General anesthesia with Remifentanil combined with Sevoflurane is effective during cesarean section in primiparas,which can effectively maintain the stability of hemodynamics,has little impact on the newborn,and can inhibit the release of inflammatory cytokines to ensure the safety of mother and baby.It can be used as one of the safe and effective anesthesia methods of cesarean section.