七氟醚联合瑞芬太尼在剖宫产术中的应用及对产妇血浆炎性细胞因子的影响
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摘要
目的:分析七氟醚联合瑞芬太尼在剖宫产术中的应用效果及对产妇血浆炎性细胞因子的影响。方法:将本院91例剖宫产产妇按随机数字表法分为对照组48例、观察组43例,对照组给予异丙酚联合瑞芬太尼麻醉,观察组给予七氟醚联合瑞芬太尼麻醉。比较两组麻醉恢复情况,血浆炎性细胞因子,血流动力学,新生儿阿氏(Apgar)评分,术中和术后出血量,不良反应。结果:观察组自主呼吸恢复时间、拔管时间、睁眼时间均少于对照组(P<0.05)。术后两组血浆炎性细胞因子水平均较术前上升,但观察组低于对照组(P<0.05);两组血流动力学指标均下降,但观察组变化幅度更小(P<0.05)。两组新生儿Apgar评分、术中及术后24h出血量、不良反应发生情况比较无差异(P>0.05)。结论:七氟醚联合瑞芬太尼在剖宫产麻醉中的应用效果确切,能够抑制血浆炎性细胞因子的释放,对母婴安全性高,可作为剖宫产安全有效的麻醉方式之一。
Objective: To analyze the effect of sevoflurane combined with remifentanil in cesarean section, and to analyze its influence on plasma inflammatory cytokines. Methods: 91 women who wanted cesarean section were divided into control group(48 cases) and observation group(43 cases) according to random number table method. The women in control group were given anesthesia by propofol combined with remifentanil, and the women in observation group were given anesthesia by sevoflurane combined with remifentanil. The situation of anesthetic recovery, plasma inflammatory cytokines levels, hemodynamics value, neonatal Apgar score, volume of intraoperative or postoperative blood loss, and adverse reactions rate of women were compared between the two groups. Results: The time of spontaneous breathing recovery, removal tube, and eye opening of women in observation group were significant shorter than those of women in control group(P<0.05). The levels of plasma inflammatory cytokines of all women increased after cesarean, and the levels of plasma inflammatory cytokines of women in observation group were significant lower than those of women in control group(P<0.05). After surgery, the hemodynamic indexes of women in both groups decreased significantly, while that of women in observation group decreased more(P<0.05). There were no significant different in Apgar score of newborns, volume of intraoperative or postoperative blood loss in 24 h after operation, and rate of adverse reaction between the two groups(P>0.05). Conclusion: Sevoflurane combined with remifentanil used in cesarean section can inhibit the release of inflammatory cytokines, improve security of mothers and babies, so it can be used as one of safe and effective anesthetic methods for cesarean section.
Objective: To analyze the effect of sevoflurane combined with remifentanil in cesarean section, and to analyze its influence on plasma inflammatory cytokines. Methods: 91 women who wanted cesarean section were divided into control group(48 cases) and observation group(43 cases) according to random number table method. The women in control group were given anesthesia by propofol combined with remifentanil, and the women in observation group were given anesthesia by sevoflurane combined with remifentanil. The situation of anesthetic recovery, plasma inflammatory cytokines levels, hemodynamics value, neonatal Apgar score, volume of intraoperative or postoperative blood loss, and adverse reactions rate of women were compared between the two groups. Results: The time of spontaneous breathing recovery, removal tube, and eye opening of women in observation group were significant shorter than those of women in control group(P<0.05). The levels of plasma inflammatory cytokines of all women increased after cesarean, and the levels of plasma inflammatory cytokines of women in observation group were significant lower than those of women in control group(P<0.05). After surgery, the hemodynamic indexes of women in both groups decreased significantly, while that of women in observation group decreased more(P<0.05). There were no significant different in Apgar score of newborns, volume of intraoperative or postoperative blood loss in 24 h after operation, and rate of adverse reaction between the two groups(P>0.05). Conclusion: Sevoflurane combined with remifentanil used in cesarean section can inhibit the release of inflammatory cytokines, improve security of mothers and babies, so it can be used as one of safe and effective anesthetic methods for cesarean section.
引文
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[17] 叶永科,YEYong-ke.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):2155-2156.
[18] Haghshenas Mojaveri M,Mohammadzadeh I,et al.The comparison of serum interleukin-6 of mothers in vaginal and elective cesarean delivery[J].Caspian J Intern Med,2014,5(4):223-226.
[19] 夏成兴,李学东.血清细胞因子对术后患者状态评估中的应用研究进展[J].标记免疫分析与临床,2016,23(8):945-948.
[20] 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.
[21] 王浩,彰宁.不同麻醉方式在剖宫产术中的麻醉效能及对产妇血流动力学的影响[J].中国妇幼保健,2017,32(21):5466-5469.
[2] Garite TJ,Combs CA,Maurel K,et al.A multicenter prospective study of neonatal outcomes at less than 32 weeks associated with indications for maternal admission and delivery[J].Am J Obstet Gynecol,2017217(1):72.e1-72.e9.
[3] 任冉,潘瑞芹,张忠原.剖宫产产妇围术期抗炎及促炎指标的变化[J].实用临床医药杂志,2016,20(19):187-188.
[4] 季一勤,匡华勇,何绍明.全身麻醉下剖宫产对产妇及胎儿影响的研究近况[J].临床军医杂志,2015,43(1):81-84.
[5] Benevides ml,Brandao VC,Lovera JI.Perioperative management of a morbidly obese pregnant patient undergoing cesarean sectionunder general anesthesia- case report[J].Rev Bras Anestesiol,2016,66(4):418-422.
[6] 蔺杰,白耀武,李桂荣.瑞芬太尼在妊高征产妇全麻诱导时对产妇血气指标及新生儿Apgar评分的影响[J].中国煤炭工业医学杂志,2017,20(1):20-22.
[7] 中华医学会妇产科学分会产科学组.剖宫产手术的专家共识(2014)[J].中华妇产科杂志,2014,49(10):721-724.
[8] 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.
[9] Moaveni D,Cohn J,Brodt J,et al.Scleroderma and pulmonary hypertension complicating two pregnancies:use of neuraxial anesthesia,general anesthesia,epoprostenol and a multidisciplinary approach for cesarean delivery[J].Int J Obstet Anesth,2015,24(4):375-382.
[10] 何利平,李娟娟,HeLiping,等.全身麻醉用于剖宫产的临床观察[J].中国医师进修杂志,2015,38(s1):79-80.
[11] 李利.瑞芬太尼-异丙酚-阿曲库铵复合全身麻醉用于剖宫产术的效果[J].实用临床医药杂志,2015,19(11):138-139.
[12] 崔万宏,袁学芝.低剂量丙泊酚复合瑞芬太尼全身静脉麻醉对剖宫产疼痛敏感度的影响[J].医学综述,2016,22(22):4529-4531.
[13] 李燕.瑞芬太尼对全身麻醉患者围拔管期应激反应的影响[J].现代中西医结合杂志,2015,24(35):3967-3970.
[14] Altun C,Borazan H,Sahin O,et al.Effects of anesthesia type on short-term postoperative cognitive function in obstetric patients following cesarean section[J].J Turk Ger Gynecol Assoc,2015,16(4):219-225.
[15] 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.
[16] 赵明晔,苏子敏,葛圣金.七氟醚在临床麻醉中应用的最新进展[J].中国临床医学,2015,22(6):837-840.
[17] 叶永科,YEYong-ke.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):2155-2156.
[18] Haghshenas Mojaveri M,Mohammadzadeh I,et al.The comparison of serum interleukin-6 of mothers in vaginal and elective cesarean delivery[J].Caspian J Intern Med,2014,5(4):223-226.
[19] 夏成兴,李学东.血清细胞因子对术后患者状态评估中的应用研究进展[J].标记免疫分析与临床,2016,23(8):945-948.
[20] 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.
[21] 王浩,彰宁.不同麻醉方式在剖宫产术中的麻醉效能及对产妇血流动力学的影响[J].中国妇幼保健,2017,32(21):5466-5469.