不同浓度七氟醚全麻诱导对剖宫产围术期产妇和新生儿的作用研究
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摘要
目的探讨不同浓度七氟醚全麻诱导对剖宫产围术期产妇和新生儿的作用。方法选取我院2015年2月~2017年8月收治的全麻下行剖宫产的100例产妇,按照随机数字表法平均分为四组,每组各25例,A组予以8%七氟醚全麻诱导,B组予以6%七氟醚全麻诱导,C组予以4%七氟醚全麻诱导,D组予以2%七氟醚全麻诱导。比较四组产妇麻醉诱导前(T0)、诱导后气管插管前即刻(T1)、气管插管后(T2)、手术开始时(T3)时的收缩压(SBP)、舒张压(DBP)、心率(HR)值以及出血量、意识消失时间、手术时间、动脉氧分压(Pa O2)、二氧化碳分压(Pa CO2)、p H值、Apgar评分。结果 A组产妇T1、T2、T3时的SBP、DBP、HR值均低于T0,时(P<0.05),B组T1、T2时的SBP、DBP、HR值均低于T0时(P<0.05),C组T1、T2、T3时的SBP、DBP、HR值与T0时比较,差异均无统计学意义(P>0.05),D组T2、T3时的SBP、DBP、HR值均高于T0时(P<0.05)。D组的出血量显著多于A、B、C组,意识消失时间、手术时间均显著长于A、B、C组(P<0.05)。四组产妇的Pa O2、Pa CO2、p H值比较,差异均无统计学意义(P>0.05);四组产妇5 min时的新生儿Apgar评分均高于1 min时(P<0.05)。结论吸入不同浓度的七氟醚均可安全用于剖宫产全麻诱导,但4%七氟醚全麻诱导对行剖宫产手术的产妇影响较小,不会对新生儿造成影响。
Objective To explore the effect of different concentrations of Sevoflurane for general anesthesia induction on maternal and newborn during perioperative period of cesarean section. Methods A total of 100 parturients with cesarean section of general anesthesia treated in our hospital from February 2015 to August 2017 were selected, and they were divided into the 4 groups, and there were 25 cases in each group according to the random number table method.Group A was induced by 8% Sevoflurane for general anesthesia, group B was induced by 6% Sevoflurane for general anesthesia, group C was induced by 4% Sevoflurane for general anesthesia, and group D was induced by 2% Sevoflurane for general anesthesia. The SBP, DBP, HR before anesthesia induction(T0), immediately after induction(T1), after tracheal intubation(T2), and at the beginning of operation(T3) and bleeding volume, consciousness disappearance time,operation time, Pa O2, Pa CO2, p H value, Apgar score were compared in parturients among the four groups. Results In group A, the value of SBP, DBP and HR at T1, T2 and T3 were lower than at T0(P<0.05), in group B, the value of SBP,DBP and HR at T1 and T2 were lower than T0 time(P<0.05), there was no significant difference in SBP, DBP and HR at T1, T2 and T3 in group C when compared with T0(P>0.05). In group D, the value of SBP, DBP and HR at T2 and T3 were higher than those in T0(P<0.05). The bleeding volume in group D were significantly more than those in group A,B and C, consciousness disappearance time and operation time in group D were significantly longer than those in group A, B and C(P<0.05). There was no statistical difference in Pa O2, Pa CO2 and p H among the four groups(P>0.05), and the newborn Apgar score of 5 min in the 4 groups were higher than those of at 1 min(P<0.05). Conclusion Different concentrations of Sevoflurane inhalation can be safely used for induction of general anesthesia in cesarean section, but4% Sevoflurane for general anesthesia induction has little effect on the parturients undergoing cesarean section, and will not affect the newborn.
Objective To explore the effect of different concentrations of Sevoflurane for general anesthesia induction on maternal and newborn during perioperative period of cesarean section. Methods A total of 100 parturients with cesarean section of general anesthesia treated in our hospital from February 2015 to August 2017 were selected, and they were divided into the 4 groups, and there were 25 cases in each group according to the random number table method.Group A was induced by 8% Sevoflurane for general anesthesia, group B was induced by 6% Sevoflurane for general anesthesia, group C was induced by 4% Sevoflurane for general anesthesia, and group D was induced by 2% Sevoflurane for general anesthesia. The SBP, DBP, HR before anesthesia induction(T0), immediately after induction(T1), after tracheal intubation(T2), and at the beginning of operation(T3) and bleeding volume, consciousness disappearance time,operation time, Pa O2, Pa CO2, p H value, Apgar score were compared in parturients among the four groups. Results In group A, the value of SBP, DBP and HR at T1, T2 and T3 were lower than at T0(P<0.05), in group B, the value of SBP,DBP and HR at T1 and T2 were lower than T0 time(P<0.05), there was no significant difference in SBP, DBP and HR at T1, T2 and T3 in group C when compared with T0(P>0.05). In group D, the value of SBP, DBP and HR at T2 and T3 were higher than those in T0(P<0.05). The bleeding volume in group D were significantly more than those in group A,B and C, consciousness disappearance time and operation time in group D were significantly longer than those in group A, B and C(P<0.05). There was no statistical difference in Pa O2, Pa CO2 and p H among the four groups(P>0.05), and the newborn Apgar score of 5 min in the 4 groups were higher than those of at 1 min(P<0.05). Conclusion Different concentrations of Sevoflurane inhalation can be safely used for induction of general anesthesia in cesarean section, but4% Sevoflurane for general anesthesia induction has little effect on the parturients undergoing cesarean section, and will not affect the newborn.
引文
[1]段崇珍,鲁晓红.不同浓度七氟醚全麻诱导对剖宫产围术期产妇和新生儿的影响[J].宁夏医科大学学报,2017,39(4):443-446.
[2]翟利平,邓爱华,徐公元.双管喉罩吸入七氟醚麻醉在剖宫产术中的应用[J].广东医学,2016,37(5):756-758.
[3]冯智泉.小儿麻醉采用骶管麻醉复合七氟醚的应用效果分析[J].中国医学创新,2016,13(7):101-103.
[4]刘超,辛忠.术前右美托咪定喷鼻对全凭七氟醚吸入麻醉行腹部外科手术患儿的脑电双频指数及七氟醚半数有效浓度的影响[J].中国医药导报,2017,14(34):66-69,73.
[5]袁凤玲,肖远航,樊会芳.七氟醚复合瑞芬太尼在剖宫产术全身麻醉中的应用效果[J].河南医学研究,2017,26(9):1691-1692.
[6]王强,姚兰,冯艺,等.早产儿平稳气管插管时七氟醚的最低肺泡有效浓度[J].临床麻醉学杂志,2016,32(9):865-867.
[7]雷伟,雷怀彪,简文静,等.瑞芬太尼复合七氟醚插管全麻在剖宫产术中的应用观察[J].医学理论与实践,2017,30(13):1974-1975.
[8]谭波.七氟醚诱导在患儿全身麻醉中的效果观察[J].中外医学研究,2017,15(12):18-20.
[9]贾杰,李屹,胡祖荣,等.七氟醚联合瑞芬太尼用于产科全身麻醉对炎性细胞因子的影响[J].实用医学杂志,2015,31(11):1832-1834.
[10]郭善亮,刘小兵,周涛,等.喉罩下七氟醚吸入全麻在妊娠合并心脏病产妇剖宫产术中的应用[J].江西医药,2015,50(7):708-710.
[11]尹苏芹,许军,邹丽峰.七氟醚用于小儿扁桃体切除术全麻诱导的临床研究[J].中外医疗,2017,36(6):136-137.
[12]邓爱华.喉罩下七氟醚吸入全身麻醉在剖宫产术中的应用[J].齐齐哈尔医学院学报,2015,36(11):1599-1600.
[13]纪洪波,李泽宇.自制高浓度七氟醚快速诱导器用于儿童全身麻醉诱导的临床观察[J].国际麻醉学与复苏杂志,2015,36(10):909-912.
[14]陈景亮.静吸复合麻醉与全凭静脉麻醉在剖宫产手术中对新生儿及产妇的影响比较[J].中国临床医生杂志,2015,43(10):59-61.
[15]李屹,贾杰,孙艺娟,等.七氟醚对产科全身麻醉母体热休克蛋白70的影响[J].实用医学杂志,2016,32(17):2915-2917.
[16]叶永科.七氟醚与瑞芬太尼在剖宫产全身麻醉中的应用效果及对炎性细胞因子的影响[J].医学临床研究,2016,33(11):2155-2159.
[17]吴小平,张磊.七氟醚辅助硬膜外阻滞对剖宫产安全性的分析[J].中国妇幼健康研究,2017,28(3):309-311.
[2]翟利平,邓爱华,徐公元.双管喉罩吸入七氟醚麻醉在剖宫产术中的应用[J].广东医学,2016,37(5):756-758.
[3]冯智泉.小儿麻醉采用骶管麻醉复合七氟醚的应用效果分析[J].中国医学创新,2016,13(7):101-103.
[4]刘超,辛忠.术前右美托咪定喷鼻对全凭七氟醚吸入麻醉行腹部外科手术患儿的脑电双频指数及七氟醚半数有效浓度的影响[J].中国医药导报,2017,14(34):66-69,73.
[5]袁凤玲,肖远航,樊会芳.七氟醚复合瑞芬太尼在剖宫产术全身麻醉中的应用效果[J].河南医学研究,2017,26(9):1691-1692.
[6]王强,姚兰,冯艺,等.早产儿平稳气管插管时七氟醚的最低肺泡有效浓度[J].临床麻醉学杂志,2016,32(9):865-867.
[7]雷伟,雷怀彪,简文静,等.瑞芬太尼复合七氟醚插管全麻在剖宫产术中的应用观察[J].医学理论与实践,2017,30(13):1974-1975.
[8]谭波.七氟醚诱导在患儿全身麻醉中的效果观察[J].中外医学研究,2017,15(12):18-20.
[9]贾杰,李屹,胡祖荣,等.七氟醚联合瑞芬太尼用于产科全身麻醉对炎性细胞因子的影响[J].实用医学杂志,2015,31(11):1832-1834.
[10]郭善亮,刘小兵,周涛,等.喉罩下七氟醚吸入全麻在妊娠合并心脏病产妇剖宫产术中的应用[J].江西医药,2015,50(7):708-710.
[11]尹苏芹,许军,邹丽峰.七氟醚用于小儿扁桃体切除术全麻诱导的临床研究[J].中外医疗,2017,36(6):136-137.
[12]邓爱华.喉罩下七氟醚吸入全身麻醉在剖宫产术中的应用[J].齐齐哈尔医学院学报,2015,36(11):1599-1600.
[13]纪洪波,李泽宇.自制高浓度七氟醚快速诱导器用于儿童全身麻醉诱导的临床观察[J].国际麻醉学与复苏杂志,2015,36(10):909-912.
[14]陈景亮.静吸复合麻醉与全凭静脉麻醉在剖宫产手术中对新生儿及产妇的影响比较[J].中国临床医生杂志,2015,43(10):59-61.
[15]李屹,贾杰,孙艺娟,等.七氟醚对产科全身麻醉母体热休克蛋白70的影响[J].实用医学杂志,2016,32(17):2915-2917.
[16]叶永科.七氟醚与瑞芬太尼在剖宫产全身麻醉中的应用效果及对炎性细胞因子的影响[J].医学临床研究,2016,33(11):2155-2159.
[17]吴小平,张磊.七氟醚辅助硬膜外阻滞对剖宫产安全性的分析[J].中国妇幼健康研究,2017,28(3):309-311.