【摘要】 目的：探討丙泊酚与氯胺酮或瑞芬太尼复合麻醉应用于孕产妇5分钟剖宫产全身麻醉效果。方法：选取2019年11月-2020年11月本院5分钟剖宫产孕产妇48例，将其随机分为两组。对照组应用丙泊酚+氯胺酮麻醉，研究组应用丙泊酚+瑞芬太尼麻醉。观察比较两组在麻醉诱导前，气管插管后以及手术结束时的平均动脉压、心率、收缩压、舒张压变化情况。观察比较两组娩出新生儿1 min后的脐动脉血气情况以及娩出新生儿1、5 min的Apgar评分情况。比较两组麻醉苏醒时间，谵妄发生情况以及持续时间。结果：研究组气管插管后、手术结束时的心率、平均动脉压、收缩压、舒张压均优于对照组（P<0.05）;两组娩出新生儿1 min后的脐动脉血气情况和新生儿1、5 min Apgar评分对比，差异均无统计学意义（P>0.05）;研究组定向恢复时间、拔管时间、呼之睁眼时间、恢复自主呼吸时间均短于对照组（P<0.05）;研究组谵妄发生率低于对照组，持续时间短于对照组（P<0.05）。结论：5分钟剖宫产全身麻醉中，相对于丙泊酚+氯胺酮，丙泊酚+瑞芬太尼效果更佳，有利于患者血压和心率的稳定，且能缩短患者的苏醒时间和谵妄持续时间，减低麻醉后孕产妇的谵妄发生率，且不会影响新生儿的Apgar评分，安全性较高。

【关键词】 丙泊酚 氯胺酮 瑞芬太尼 复合麻醉 5分钟剖宫产 全身麻醉 苏醒时间 谵妄

Study on the Effect of Combined Anesthesia of Propofol and Ketamine or Remifentanil in General Anesthesia of Pregnant Women during 5-minute Cesarean Section/HE Xing. //Medical Innovation of China， 2021， 18（34）： 0-067

[Abstract] Objective： To explore the effect of combined anesthesia of Propofol and Ketamine or Remifentanil in general anesthesia of pregnant women during 5-minute cesarean section. Method： A total of 48 pregnant women who underwent a 5-minute cesarean section in our hospital from November 2019 to November 2020 were selected and randomly divided into two groups. The control group was anesthetized with Propofol + Ketamine， and the study group was anesthetized with Propofol + Remifentanil. The changes of mean arterial pressure， heart rate， systolic blood pressure and diastolic blood pressure were observed and compared between the two groups before anesthesia induction， after endotracheal intubation and at the end of operation. The umbilical artery blood gas and Apgar scores of newborns 1 and 5 min after delivery were observed and compared between the two groups. The recovery time of anesthesia， the occurrence and duration of delirium were compared between the two groups. Result： The heart rate， mean arterial pressure， systolic blood pressure and diastolic blood pressure of the study group after tracheal intubation and at the end of the operation were better than those of the control group （P<0.05）; there were no significant differences in umbilical artery blood gas and Apgar scores at 1 and 5 min between the two groups （P>0.05）; the directional recovery time， extubation time， eye opening time and recovery of spontaneous breathing in the study group were shorter than those in the control group （P<0.05）; the incidence of delirium in the study group was lower than that in the control group， duration of delirium was shorter than that of the control group （P<0.05）. Conclusion： Compared with Propofol and Ketamine， Propofol + Remifentanil is more effective in general anesthesia for 5-minute cesarean section， which is beneficial to the stability of patient’s blood pressure and heart rate， and can shorten the patient’s recovery time and delirium duration， and reduce the incidence of delirium in pregnant women after anesthesia， and will not affect the Apgar score of newborns， and the safety is high.

[Key words] Propofol Ketamine Remifentanil Combined anesthesia 5-minute cesarean section General anesthesia Recovery time Delirium

First-author’s address： Jiangmen Xinhui District Maternal and Child Health Hospital， Jiangmen 529000， China

doi：10.3969/j.issn.1674-4985.2021.34.015

临床对于分娩过程中的意外（如脐带脱垂、胎儿窘迫、子宫破裂、胎盘早剥等紧急情况）和高危孕产妇，有效改善母婴预后的方法就是快速终止妊娠[1]。5分钟剖宫产即在紧急情况下，为挽救母婴生命采取的一种即刻剖宫产，能极大程度地缩短产程，有利于降低胎儿大脑损伤的发生率，提高胎儿存活率，在改善预后方面是一种最有效的方法[2]。……