七氟醚吸入麻醉对择期剖宫产孕妇血清促炎因子及循环稳定性的影响

Influence of sevoflurane inhalation on circulation stability and serum proinflammatory factors in pregnant women undergoing elective cesarean section

目的分析七氟醚吸入麻醉对择期剖宫产孕妇循环稳定性和血清促炎性细胞因子、血流动力学的影响。方法回顾性分析收集2017年4月~2018年8月我院98例行全身麻醉下剖宫产手术产妇的临床资料,按是否选择七氟醚吸入麻醉分为七氟醚组(n=52)与对照组(n=46)。比较两组术前(T0)、切皮时(T1)、出胎时(T2)、拔管后(T3)产妇心率(HR)、收缩压(SBP)、舒张压(DBP)的变化,测定手术前后产妇白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、可溶性人肿瘤坏死因子受体Ⅱ(sTNFRⅡ)等促炎因子,记录两组新生儿血气指标及阿普加评分(Apgar)的变化,比较产妇及新生儿结局。结果与T0点比较,T1~T2点两组SBP、DBP均下降(P<0.05),七氟醚组T1~T2点SBP、DBP皆高于对照组(P<0.05);两组新生儿脐血各血气指标及新生儿娩出不同时间Apgar评分相比差异无统计学意义(P>0.05);术前,两组产妇促炎各因子水平比较差异无统计学意义(P>0.05),术后即刻,对照组IL-6、TNF-α、sTNFRⅡ水平高于七氟醚组(P<0.05);两组母婴不良事件比较差异无统计学意义(P>0.05)。结论七氟醚术中维持对全麻下剖宫产产妇血流动力学影响更小,对应激引起的细胞因子释放抑制更明显,且对新生儿无负面影响,安全可行。

Objective To analyze the influence of sevoflurane inhalation anesthesia on circulation stability and serum proinflammatory factors in pregnant women undergoing elective cesarean section.Methods The clinical data of 98 puerperae who underwent cesarean section under general anesthesia were retrospectively analyzed.The patients were divided into sevoflurane group(n=52)and control group(n=46)according to whether sevoflurane inhalation anesthesia was selected.The maternal heart rate(HR),systolic blood pressure(SBP)and diastolic blood pressure(DBP)were compared between the two groups before operation(T0),at skin incision(T1),at fetus delivery(T2)and after extubation(T3),and the proinflammatory cytokines of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and soluble human tumor necrosis factor receptorⅡ(sTNFRⅡ)were measured before and after operation,and the changes of blood gas indexes and Apgar score were recorded in the two groups,and the maternal and neonatal outcomes were compared.Results Compared with at T0,the SBP and DBP in the two groups were decreased at T1~T2(P<0.05),and the SBP and DBP in sevoflurane group at T1~T2 were higher than those in control group(P<0.05).There were no significant differences in the blood gas indexes in cord blood and the Apgar scores at different neonatal delivery times between the two groups(P>0.05).Before operation,there were no significant differences in the levels of proinflammatory cytokines between the two groups(P>0.05).Immediately after operation,the levels of IL-6,TNF-αand sTNFR II in control group were higher than those in sevoflurane group(P<0.05).There were no statistically significant differences in the maternal-infant adverse events between the two groups(P>0.05).Conclusion Intraoperative sevoflurane maintenance has a smaller effect on hemodynamics of puerperae with cesarean section under general anesthesia,and has more obvious inhibition of cytokine release caused by stress,and it has no negative impact on the neonates,thus it is safe and feasible.