瑞芬太尼靶控输注诱导全麻剖宫产对母体应激反应和新生儿结局的影响

Effects of target-controlled infusion of remifentanil on maternal stress response and oxidative stress indexes related with neonatal outcome in cesarean section under general anesthesia

目的瑞芬太尼靶控输注诱导全麻剖宫产对母体应激反应和新生儿结局相关氧化应激指标的影响。方法实施全麻下剖宫产的产妇作为研究对象,采用随机数字表法分为A组和B组,每组52例。A组采用瑞芬太尼靶控输注诱导维持麻醉,B组采用定速输注维持麻醉,比较2组母体分娩过程中不同时间点收缩压和心率变化,并收集分娩前、新生儿娩出时和分娩后30 min母体静脉血,以及新生儿脐带血,检测脂质过氧化产物丙二醛(MDA)水平,并对结果进行比较分析。结果A组和B组母体收缩压在T2、T3、T4时变化差异均无统计学意义(P>0.05),T5时收缩压明显增高,A组T5收缩压与T0比较差异无统计学意义(P>0.05),B组T5时收缩压较T0时明显降低,差异有统计学意义(P<0.05)。组间比较,A组T2、T3、T4时收缩压均低于B组,差异有统计学以(P<0.05)。A组在T1、T2时心率较前一监测点有明显波动,T4、T5时心率明显降低,与T0、T2比较差异有统计学意义(P<0.05),T3、T4时心率差异无统计学意义(P>0.05)。B组在T0、T1和T2时心率变化差异无统计学意义(P>0.05);T3时心率比较T0、T1、T2时明显增高,T4时开始明显下降,差异均有统计学意义(P<0.05)。组间比较,A组T3、T4时心率与B组比较明显降低,差异有统计学意义(P<0.05)。2组母体分娩前和分娩后30 min的血MOD水平差异无统计学意义(P>0.05);新生儿娩出时母体静脉血和脐带血中MOD水平比较,A组比B组明显下降,差异有统计学意义(P<0.05)。2组新生儿娩出后1 min、5 min Apgar评分差异无统计学意义(P>0.05)。结论瑞芬太尼靶控输注诱导在维持全麻下剖宫产产妇血压、心率稳定方面优势突出,同时可有效降低胎儿氧化应激反应损伤的风险。

Objective To investigate the effects of target-controlled infusion of remifentanil on maternal stress response and oxidative stress indexes related with neonatal outcome in cesarean section under general anesthesia.Methods The parturients who underwent cesarean section under general anesthesia in our hospital from July 2018 to March 2019 were enrolled in the study,who were divided into group A(n=52)and group B(n=52)according to random number table method.The parturients in group A were given target-controlled infusion of remifentanil to maintain anesthesia effects,however,the parturients in group B were given constant speed infusion of remifentanil to maintain anesthesia effects.The changes of systolic blood pressure and heart rate at different time points during childbirth,and the MDA levels in maternal venous blood before childbirth,on childbirth and at 30min after childbirth,as well as in neonatal cord blood were observed and compared between the two groups.Results There were no significant differences in the changes of maternal systolic blood pressure at T2,T3,or T4 between group the two groups(P>0.05),moreover,there were no significant differences in groups A between T5 and T0(P>0.05),however,the systolic blood pressure levels at T5 in group B were significantly decreased(P<0.05).The systolic blood pressure levels at T2,T3 and T4 in group A were significantly lower than those in group B(P<0.05).In addition the heart rates at T4 and T5 in group A were significantly lower than those at T0 and T2(P<0.05),but there were no significant differences between T3 and T4(P>0.05).There were no significant differences in the changes of heart rate in group B among T0,T1,T2(P>0.05),however,which at T3 were significantly higher than those at T0,T1 and T2(P<0.05).Moreover there were no significant differences in the MDA levels in the parturients before childbirth and at 30min after childbirth(P>0.05),however,which in group A were significantly lower than those in group B(P<0.05).Besides there were no significant differences in Apgar scores at 1min and 5min after childbirth between the two groups(P>0.05).Conclusion The target-controlled infusion of remifentanil in cesarean section under general anesthesia has prominent advantages in maintaining the stability of blood pressure and heart rate,which can effectively reduce the risk of fetal oxidative stress injury.