5%~8%七氟醚与瑞芬太尼全麻对即刻剖宫产产妇及新生儿的影响研究

目的观察异丙酚复合5%~8%七氟醚全麻、异丙酚复合瑞芬太尼全麻对即刻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2019年6月—2020年6月四川省妇幼保健院ASA分级Ⅰ~Ⅱ级、单活胎足月妊娠的即刻剖宫产产妇60例,分为异丙酚复合5%~8%七氟醚全麻组(S组,n=30)和异丙酚复合瑞芬太尼麻醉组(R组,n=30),S组采用吸入5%~8%七氟醚诱导后气管插管;R组产妇采用瑞芬太尼诱导后气管插管,记录产妇麻醉效果,手术前后各项指标以及新生儿脐动脉血气分析结果,分析2组麻醉方法对产妇及新生儿的影响。结果S组内产妇MAP指标相较于麻醉前(T_(1)),T_(3)、T_(5)时显著降低,HR指标相较于麻醉前(T_(1)),T_(2)、T_(4)、T_(5)时显著降低,差异均有统计学意义(P<0.05)。R组内,产妇MAP指标相较于麻醉前(T_(1)),T_(3)时显著降低,HR指标相较于麻醉前(T_(1)),T_(2)、T_(4)、T_(5)时显著降低,差异均具有统计学意义(P<0.05)。S组与R组间比较,HR在T_(2)时点S组显著高于R组,MAP在T_(2)、T_(3)时点S组显著高于R组,差异均具有统计学意义(P<0.05)。新生儿血气分析PaO_(2)S组高于R组,HCO_(3)^(-)S组低于R组(P<0.05);PH、Glu2组差异无统计学意义(P>0.05)。结论在即刻剖宫产手术产妇的麻醉中,异丙酚联合5%~8%七氟醚诱导的全身麻醉可维持产妇血流动力学稳定,且新生儿的脐动脉血气分析结果更优。

盐酸布比卡因腰麻在剖宫产手术中的应用

盐酸布比卡因在临床常用于剖宫产术中麻醉,要求麻醉效果达到起效快、镇痛效果好、保持肌肉松弛等目的,同时还需要保持产妇血流动力学处于平稳的状态,并且不对胎儿造成严重的影响。本文主要针对盐酸布比卡因腰麻在剖宫产手术中的应用研究进行综述和总结。

对比生理盐水与脑脊液分别配制成0.5%左丁哌卡因行腰硬联合麻醉用于剖宫产的体会

目的:探讨用生理盐水与脑脊液(CSF)配制成0.5%左丁哌卡因行腰硬联合麻醉用于剖宫产的体会。方法:收治足月妊娠产妇30例,分为A组和B组,每组各15例。A组采用0.75%左丁哌卡因1.5 mL+生理盐水0.5 mL,B组采用0.75%左丁哌卡因1.5 mL+CSF 0.5 mL。结果:注药后1、2 min,A组致血压下降,心率显著升高。B组对血压、心率无明显影响。两组间1 min Apgar评分无显著差异。结论:用CSF稀释左丁哌卡因,安全有效,效果好。

Venous hemodynamic changes of lower extremity during gynecological laparoscopy

Objective: To study the effect of CO2 pneumoperitoneum and the special 30 degree head-down tilt position on the venous hemodynamics in the lower extremity. Methods: Color doplex ultrasound was adopted to evaluate the diameter and blood flow velocity of the right femoral vein of 18 patients undergoing gynecologic laparoscopy under the same pressure of pneumoperitoneum of 12 mmHg. The diameter of femoral vein and the flow velocity were measured; the blood flow volume was calculated based on the equation of Q = vπr2 . Result: After establishment of pneumoperitoneum, the dilation of the femoral vein and the decrease in the velocity and volume can be observed (P < 0.05). And the 30 degree head-down position could increase the flow velocity and volume of the femoral vein and decrease the diameter of the vessel ( P < 0.05). At 30 minutes of the 30 degree head-down tilt position, the blood flow ameliorated compared with that in prone position after the establishment of pneumoperitoneum. After deflation of pneumoperitoneum, the femoral vein remained dilated( P < 0. 05). Conclusion: During laparoscopy, CO2 pneumoperitoneum may result in the dilation of the vein in lower extremity and retar dance of blood flow. The 30 degree Trendlenburg position can ameliorate the blood flow in the lower extremity. The deflation of the pneumoperitoneum cannot eliminate the effect of CO2 pneumoperitoneum on the lower extremity veins, which may predispose deep venous thrombosis after laparoscopy.