何娟 罗利平

摘 要 目的：探讨剖宫产术应用丙泊酚复合雷米芬太尼全身麻醉对产妇及新生儿的影响。方法：选取50例剖宫产术产妇，根据不同的麻醉方法分为对照组及研究组各25例，对照组行常规全身麻醉，研究组行丙泊酚复合雷米芬太尼全身麻醉，比较两组产妇血流动力学指标变化、新生儿相关情况及脐血血气指标。结果：两组麻醉前及拔管后心率及平均动脉压、子宫切开至胎儿娩出时间（U-D）、新生儿氧摄取率（oxygen extraction ratio， ERO2）、1 min及5 min Apgar评分、动静脉脐血血气比较无统计学差异（P>0.05），而研究组切皮时的心率及平均动脉压均显著高于对照组，麻醉开始至胎儿娩出时间（I-D）显著低于对照组（P<0.05）。结论：丙泊酚复合雷米芬太尼对ERO2无明显影响，母体血流动力学及新生儿脐血血气指标稳定，在剖宫产中具有一定的应用价值。

关键词 剖宫产术 全身麻醉 丙泊酚 雷米芬太尼 新生儿 氧摄取率

中图分类号：R614.27； R719.8 文献标志码：B 文章编号：1006-1533（2019）01-0027-03

Effect of general anesthesia with propofol combined with remifentanil on 25 parturients and neonates during cesarean section

HE Juan1， LUO Liping2*（1. Department of Anesthesiology， the Peoples Hospital of Kaizhou District， Chongqing 405400， China； 2. Department of Obstetrics， the Peoples Hospital of Kaizhou District， Chongqing 405400， China）

ABSTRACT Objective： To explore the effect of general anesthesia with propofol combined with remifentanil on parturients and newborns during cesarean section. Methods： Fifty parturients undergoing cesarean section were divided into a control group and a study group based on their different anesthesia methods. The control group underwent general anesthesia while the study group underwent general anesthesia with propofol and remifentanil. The changes of hemodynamics， neonatal related conditions and umbilical cord blood gas were compared between the two groups. Results： There were no significant differences in heart rate and mean arterial pressure before and after anesthesia， and the time from uterine incision to delivery of the fetus （U-D）， neonatal oxygen ratio （ERO2）， Apgar score at 1 min and 5 min and arteriovenous umbilical blood gas between the two groups （P>0.05）， however， the heart rate and mean arterial pressure at incision time was significantly longer and the time from the initiation of anesthesia to the delivery of the fetus （I-D） was significantly shorter in the study group than the control group （P<0.05）. Conclusion： Propofol combined with remifentanil has no significant effect on neonatal ERO2. Maternal hemodynamics and neonatal umbilical cord blood gas are stable. It has certain application value in cesarean section.

KEy WORDS cesarean section； general anesthesia； propofol； remifentanil； newborn； oxygen uptake

近年來，随着人们分娩意识的改变及剖宫产指征的放宽，剖宫产率逐年增长。但剖宫产术对麻醉效果要求较高，如何选择安全有效的麻醉药物稳定产妇的血流动力学指标、避免影响新生儿呼吸循环功能一直是临床研究的热点[1]。既往临床在剖宫产术中常采用椎管内麻醉，但常因部分产妇存在脊柱病变、凝血功能障碍及精神认知障碍或胎儿严重宫内窘迫等因素而选择全身麻醉[2-3]。雷米芬太尼作为一种新型的超短效阿片受体激动剂，在体内代谢快，重复用药无蓄积作用，且起效快、消除快，可抑制先兆子痫、重度血小板减少及严重心脏病产妇全麻插管的应激反应。本研究选取50例剖宫产术产妇为研究对象，探讨剖宫产术全身麻醉应用丙泊酚复合雷米芬太尼对产妇及新生儿氧摄取率的影响。