瑞芬太尼全身麻醉对剖宫产产妇血流动力学及新生儿结局的影响

Effects of remifentanil general anesthesia on hemodynamics of cesarean section parturients and neonatal outcome

目的探讨瑞芬太尼全身麻醉对剖宫产产妇血流动力学及新生儿结局的影响。方法纳入我院2019年7月至2020年7月收治的100例剖宫产产妇,根据麻醉方案不同将其分为对照组(n=50,常规麻醉)和试验组(n=50,瑞芬太尼全身麻醉)。比较两组的麻醉效果。结果拔管时、术后24 h,两组的皮质醇(Cor)、心房利钠肽(ANP)及C反应蛋白(CRP)水平均高于麻醉前,但试验组低于对照组(P<0.05)。插管后至手术结束时(T_(1)~T_(3))时,两组的平均动脉压(MAP)、心率(HR)均低于麻醉前(T_(0))时,但试验组高于对照组(P<0.05);T_(1)、T_(3)时,试验组的中心静脉压(CVP)、心排血量(CO)与T0时无显著差异(P>0.05)。两组的出生1 min Apgar评分及脐动脉血气指标无显著差异(P>0.05)。术后,试验组的白细胞分化抗原3阳性(CD3_(+))、白细胞分化抗原4阳性(CD4^(+))、白细胞分化抗原8阳性(CD8_(+))及CD4^(+)/CD8^(+)与术前无显著差异(P>0.05)。结论瑞芬太尼全身麻醉有助于减轻产妇的应激反应,维持产妇血流动力学稳定,且对新生儿影响较小,麻醉镇痛效果显著。

Objective To investigate the effects of remifentanil general anesthesia on hemodynamics of cesarean section parturients and neonatal outcome.Methods A total of 100 cesarean section parturients admitted in our hospital from July 2019 to July 2020 were included and divided into control group(n=50,routine anesthesia)and experimental group(n=50,remifentanil general anesthesia)according to different anesthesia schemes.The anesthetic effects of the two groups were compared.Results At extubation and 24 h after operation,the levels of cortisol(Cor),atrial natriuretic peptide(ANP)and C-reactive protein(CRP)in the two groups were higher than those before anesthesia,but those in the experimental group were lower than the control group(P<0.05).From intubation to the end of operation(T_(1)-T_(3)),the mean arterial pressure(MAP)and heart rate(HR)of the two groups were lower than those before anesthesia(T_(0)),but those in the experimental group were higher than the control group(P<0.05);there were no significant differences in central venous pressure(CVP)and cardiac output(CO)between T_(1),T_(3) and T_(0) in the experimental group(P>0.05).There were no significant differences in Apgar score at 1 min of birth and umbilical artery blood gas indexes between the two groups(P>0.05).After operation,the cluster of differentiation 3 positive(CD3^(+)),cluster of differentiation 4 positive(CD4^(+)),cluster of differentiation 8 positive(CD8+)and CD4^(+)/CD8^(+)in the experimental group were not significantly different from those before operation(P>0.05).Conclusion Remifentanil general anesthesia is helpful to reduce the stress response of parturients,and maintain the hemodynamics stability of parturients,which has little influence on newborns and remarkable anesthetic and analgesic effect.