欢迎访问《现代生物医学进展》编辑部！

目的；探讨硬膜外麻醉、蛛网膜下腔- 硬膜外麻、气管插管全麻三种不同麻醉方式对剖宫产产妇血流动力学及胎儿的影响。方法：纳入行择期剖宫产产妇152 例，采用随机表法将其分为硬膜外组(48 例)、腰硬联合麻醉组(52 例)、气管内插管全麻组(52 例)。观察麻醉前正常状态时(T1)、麻醉成功后5 min (T2)、胎儿娩出时(T3)三个时间点产妇SBP、DBP、HR、SV、CO、SVR 及胎儿相关指标，包括出生后1 min、5 min Apgar 评分、脐动脉血pH、PCO2、PO2。结果：硬膜外麻、腰麻- 硬膜外联合麻醉、全麻三组间麻醉起效时间有明显统计学差异(P<0.05)，气管内插管全麻组起效时间最快。三组间在T1 时间点SBP、DBP、HR、SV、CO、SVR差异无统计学意义(P>0.05)。在T2 时间点，硬膜外麻、联合麻醉、全麻三组SBP、DBP、HR、SVR水平均较T1 时间点明显降低，差异有统计学意义(P<0.05)。T2 时间点，全麻组SBP、DBP、HR、SVR 水平高于硬膜外、联合麻醉组(P<0.05)。T3 时间点三组SBP、DBP、HR、 SV、CO 水平均较T2 时间相比差异有统计学意义(P<0.05)。T3 时间点，全麻组SBP、DBP、SVR高于其他两组，心率低于其他两组，差异有统计学意义(P<0.05)。三组间新生儿出生后1 min Apagr、5 min Apgar 评分、脐动脉血学pH、PCO2无统计学差异(P>0.05)。三组间脐动脉血PO2有明显统计学差异(P<0.05)，气管内插管全麻组脐动脉血PO2最高。结论：三种麻醉均可以用于剖宫产术，全麻剖宫产术对产妇血流动力学影响最小，起效快，但对胎儿脐动脉血氧浓度有一定的影响。

英文摘要:

Objective:To explore the influence of three different anesthetic methods including epidural anesthesia, spinal-epidural anesthesia and endotracheal intubation anesthesia on the maternal hemodynamics and newborns in cesarean delivery.Methods:A total of 152 pregnant women were included in this research. They were randomly divided into epidural group (48 cases), spinal-epidural anesthesia group (52 cases) and endotracheal anesthesia group (52 cases). The maternal SBP, DBP, HR, SV, CO and SVR were observed and recorded respectively at the normal state before anesthesia (T1), 5 min after a successful anesthesia (T2) and fetal childbirth (T3), so were the fetal related indicators, including Apgar scores at 1 min and 5 min after birth, pH, PCO2 and PO2 in umbilical artery blood.Results:The anesthesia narcotic effects between three groups have significantly statistical difference (P<0.05). The endotracheal anesthesia group started work firstly. At the T1 time point, there was no statistical difference in SBP, DBP, HR, SV, CO and SVR between the three groups (P>0.05). The SBP, DBP, HR and SVR levels at T2 time point of the three groups were significantly lower than at T1 time point, and the differences were statistically significant (P<0.05). At T2 time point, the BP, DBP, HR and SVR levels in general anesthesia group were higher than in epidural group and spinal-epidural anesthesia group (P<0.05). At T3 time point, the SBP, DBP, HR, SV and CO levels of the three groups had statistical difference as compared with those at T2 time point (P<0.05). The SBP, DBP, SVR levels were higher in anesthesia group than in other two groups (P<0.05), but the heart rate was lower in anesthesia group than in other two groups (P<0.05). The 1 min Apagr scores, 5 min Apgar scores, umbilical artery blood pH and PCO2 of the newborns had no statistical difference between three groups (P>0.05). Umbilical arterial blood PO2 has significantly statistical differences between three groups (P<0. 05), and endotracheal anesthesia group had the highest PO2.Conclusion:Three kinds of anesthesia can be used for cesarean section. General anesthesia has minimal impacts on the maternal hemodynamics, and work fast, but it has certain effects on the fetal umbilical arterial blood oxygen concentration.

查看全文查看/发表评论下载PDF阅读器

关闭