腰硬联合麻醉与气管插管全身麻醉对剖宫产手术新生儿呼吸的影响
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摘要
目的分析腰硬联合麻醉与气管插管全身麻醉对剖宫产手术新生儿呼吸的影响。方法选取我院2015年9月~2017年1月的90例剖宫产手术产妇,随机分为腰硬联合组和全麻组,各45例。全麻组给予气管插管全身麻醉,腰硬联合组给予腰硬联合麻醉。比较两组的新生儿需胸外按压、辅助呼吸和采用药物复苏所占比例,剖宫产手术时间,切皮至取出胎儿时间,新生儿首次呼吸时间,出生后1、5、10 min新生儿Apgar评分,新生儿脐动脉血血气分析指标。结果两组新生儿的需胸外按压、辅助呼吸和采用药物复苏所占比例比较,差异无统计学意义(P>0.05)。两组出生后5、10 min的新生儿Apgar评分比较,差异无统计学意义(P>0.05)。腰硬联合组出生后1 min的新生儿Apgar评分高于全麻组,差异有统计学意义(P<0.05)。两组的剖宫产手术时间、切皮至取出胎儿时间比较,差异无统计学意义(P>0.05)。腰硬联合组的新生儿首次呼吸时间短于全麻组,差异有统计学意义(P<0.05)。两组的新生儿脐动脉血血气分析指标比较,差异无统计学意义(P>0.05)。结论腰硬联合麻醉与气管插管全身麻醉对剖宫产手术新生儿呼吸的影响不同,其中腰硬联合麻醉对剖宫产手术新生儿呼吸的影响更小,可缩短首次呼吸时间,提高出生即刻患儿的Apgar评分,减少药物复苏和辅助呼吸等的应用,值得推广。
Objective To analyze the influence of combined spinal-epidural anesthesia and tracheal intubation general anesthesia on neonatal breathing in cesarean section surgery.Methods 90 cases of cesarean section surgery in our hospital from September 2015 to January 2017 were selected and randomly divided into the combined spinal-epidural anesthesia group and the general anesthesia group,45 cases in each group.The general anesthesia group was given tracheal intubation general anesthesia.the combined spinal-epidural anesthesia group was given combined spinal-epidural anesthesia.The ratio of neonatal chest compression,assisted respiration and drug resuscitation,the time of cesarean section,the time from skin incision to the time of taking out the fetus,and the first breath time of the newborn,the score of neonatal Apgar at 1,5,10 min after birth,neonatal umbilical artery blood gas analysis index were compared between the two groups.Results There was no significant difference in the ratio of chest compression,assisted respiration and drug resuscitation in neonates between the two groups(P >0.05).There was no significant difference in the neonatal Apgar scores at 5 and 10 min after birth between the two groups(P>0.05).The neonatal Apgar score at 1 min after birth in the combined spinal-epidural anesthesia group was higher than that in the general anesthesia group,with significant difference(P<0.05).There was no significant difference in the time of cesarean section,the time from skin incision to the time of taking out the fetus between the two groups(P>0.05).The first breath time of the newborn in the combined spinalepidural anesthesia group was shorter than that in the general anesthesia group,with significant difference(P<0.05).There was no significant difference in the neonatal umbilical artery blood gas analysis index between the two groups(P>0.05).Conclusion The influence of combined spinal-epidural anesthesia and tracheal intubation general anesthesia on the neonatal respiratory in cesarean section surgery is different,the influence of combined spinal-epidural anesthesia on neonatal breathing in cesarean section surgery is less,which can shorten the first breathing time and improve the birth immediate children with Apgar score,reduce drug recovery and assisted breathing applications,it is worth promoting.
Objective To analyze the influence of combined spinal-epidural anesthesia and tracheal intubation general anesthesia on neonatal breathing in cesarean section surgery.Methods 90 cases of cesarean section surgery in our hospital from September 2015 to January 2017 were selected and randomly divided into the combined spinal-epidural anesthesia group and the general anesthesia group,45 cases in each group.The general anesthesia group was given tracheal intubation general anesthesia.the combined spinal-epidural anesthesia group was given combined spinal-epidural anesthesia.The ratio of neonatal chest compression,assisted respiration and drug resuscitation,the time of cesarean section,the time from skin incision to the time of taking out the fetus,and the first breath time of the newborn,the score of neonatal Apgar at 1,5,10 min after birth,neonatal umbilical artery blood gas analysis index were compared between the two groups.Results There was no significant difference in the ratio of chest compression,assisted respiration and drug resuscitation in neonates between the two groups(P >0.05).There was no significant difference in the neonatal Apgar scores at 5 and 10 min after birth between the two groups(P>0.05).The neonatal Apgar score at 1 min after birth in the combined spinal-epidural anesthesia group was higher than that in the general anesthesia group,with significant difference(P<0.05).There was no significant difference in the time of cesarean section,the time from skin incision to the time of taking out the fetus between the two groups(P>0.05).The first breath time of the newborn in the combined spinalepidural anesthesia group was shorter than that in the general anesthesia group,with significant difference(P<0.05).There was no significant difference in the neonatal umbilical artery blood gas analysis index between the two groups(P>0.05).Conclusion The influence of combined spinal-epidural anesthesia and tracheal intubation general anesthesia on the neonatal respiratory in cesarean section surgery is different,the influence of combined spinal-epidural anesthesia on neonatal breathing in cesarean section surgery is less,which can shorten the first breathing time and improve the birth immediate children with Apgar score,reduce drug recovery and assisted breathing applications,it is worth promoting.
引文
[1]廖辉.硬膜外麻醉与腰硬联合麻醉在剖宫产术中的应用效果比较[J].中国急救医学,2016,36(Z1):29-30.
[2]李圣君.罗哌卡因复合舒芬太尼腰硬联合麻醉在剖宫产术中的应用[J].山东医药,2012,52(2):93-94.
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[4]陈志强,雷洪伊,叶小平,等.腰硬联合麻醉下剖宫产术中左侧斜卧位对产妇血流动力学的影响[J].广东医学,2016,37(1):34-36.
[5]李梦倩,孙凯,吴树彪,等.腰硬联合麻醉下剖宫产术中甲氧明的用药时机[J].郑州大学学报(医学版),2016,51(1):119-122.
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[7]贺晶,闫雪.腰硬联合麻醉与硬膜外麻醉对重度子痫前期剖宫产产妇血流动力学和新生儿Apgar评分的影响[J].中国实验诊断学,2016,20(10):1709-1712.
[8]曹云.剖宫产手术行腰硬联合麻醉对术中低血压的预防及处理[J].昆明医科大学学报,2016,37(3):85-87.
[9]Hicklin K,Ivy JS,Myers ER,et al.Simulation of labor:a study of the relationship between cesarean section rates and the time spent in labor[A]//Simulation Conference[C].IEEE,2015:1269-1280.
[10]郭会江,马春梅,谢秋明,等.小剂量甲氧明、麻黄碱联合预防剖宫产腰硬联合麻醉术中低血压的效果[J].中国医药导报,2016,13(31):93-96.
[11]杨敏.剖宫产采用腰硬联合与硬膜外麻醉术后镇痛效果临床对比研究[J].中国医药导刊,2016,18(6):599-601.
[12]陈洁.腰硬联合麻醉对妊娠期高血压疾病剖宫产产妇血流动力学的影响[J].中国妇幼保健,2016,31(1):208-210.
[13]Berlac JF,Skovlund CW,Lidegaard O,et al.Obstetrical and neonatal outcomes in women following gastric bypass:a Danish national cohort study[J].Acta Obstet Gynecol Scand,2014,93(5):447-453.
[14]顾荣.罗哌卡因联合舒芬太尼在剖宫产麻醉中的应用效果[J].中外医学研究,2016,14(35):58-60.
[15]曹乐卿.腰硬联合麻醉与气管插管全身麻醉对剖宫产手术新生儿呼吸的影响[J].中国基层医药,2016,23(18):2736-2739.
[2]李圣君.罗哌卡因复合舒芬太尼腰硬联合麻醉在剖宫产术中的应用[J].山东医药,2012,52(2):93-94.
[3]Batista M,Moreno C,Vilar J,et al.Neonatal viability evaluation by Apgar score in puppies delivered by cesarean section in two brachycephalic breeds(English and French bulldog)[J].Anim Reprod Sci,2014,146(3-4):218-226.
[4]陈志强,雷洪伊,叶小平,等.腰硬联合麻醉下剖宫产术中左侧斜卧位对产妇血流动力学的影响[J].广东医学,2016,37(1):34-36.
[5]李梦倩,孙凯,吴树彪,等.腰硬联合麻醉下剖宫产术中甲氧明的用药时机[J].郑州大学学报(医学版),2016,51(1):119-122.
[6]Tinelli A,Malvasi A,Mynbaev OA,et al.The surgical outcome of intracapsular cesarean myomectomy.A match control study[J].J Matern Fetal Neonatal Med,2014,27(1-2):66-71.
[7]贺晶,闫雪.腰硬联合麻醉与硬膜外麻醉对重度子痫前期剖宫产产妇血流动力学和新生儿Apgar评分的影响[J].中国实验诊断学,2016,20(10):1709-1712.
[8]曹云.剖宫产手术行腰硬联合麻醉对术中低血压的预防及处理[J].昆明医科大学学报,2016,37(3):85-87.
[9]Hicklin K,Ivy JS,Myers ER,et al.Simulation of labor:a study of the relationship between cesarean section rates and the time spent in labor[A]//Simulation Conference[C].IEEE,2015:1269-1280.
[10]郭会江,马春梅,谢秋明,等.小剂量甲氧明、麻黄碱联合预防剖宫产腰硬联合麻醉术中低血压的效果[J].中国医药导报,2016,13(31):93-96.
[11]杨敏.剖宫产采用腰硬联合与硬膜外麻醉术后镇痛效果临床对比研究[J].中国医药导刊,2016,18(6):599-601.
[12]陈洁.腰硬联合麻醉对妊娠期高血压疾病剖宫产产妇血流动力学的影响[J].中国妇幼保健,2016,31(1):208-210.
[13]Berlac JF,Skovlund CW,Lidegaard O,et al.Obstetrical and neonatal outcomes in women following gastric bypass:a Danish national cohort study[J].Acta Obstet Gynecol Scand,2014,93(5):447-453.
[14]顾荣.罗哌卡因联合舒芬太尼在剖宫产麻醉中的应用效果[J].中外医学研究,2016,14(35):58-60.
[15]曹乐卿.腰硬联合麻醉与气管插管全身麻醉对剖宫产手术新生儿呼吸的影响[J].中国基层医药,2016,23(18):2736-2739.