喉罩通气全麻剖宫产对母婴影响的临床研究.docVIP

喉罩通气全身麻醉与硬膜外阻滞和蛛网膜下腔阻滞麻醉用于剖宫产的比较 宋村笛1 裘毅敏1 黄小静2 朱慧1 汪正平2 【摘 要】 目的 比较喉罩通气全麻、硬膜外阻滞和腰麻三种麻醉方式对新生儿及对产妇术后恢复的影响。方法 择期剖宫产产妇90例，随机分为全麻、硬膜外阻滞和腰麻组。全麻组产妇依次静注维库溴铵2mg、氯胺酮30～40mg、丙泊酚1.0mg/kg、琥珀胆碱1.5mg/kg诱导后插入喉罩，吸入1％～1.5％七氟烷维持麻醉。胎儿娩出后适当给予芬太尼 、咪达唑仑和曲马多。三组均于胎儿娩出即刻抽取胎儿脐动脉血进行血气分析，并记录新生儿娩出1min和5min的Apgar评分以及1d～3d和5d神经行为评分(neonatal behavioral neurological assessment，NBNA)。记录术后1h和24h时产妇的疼痛数字分级评分（numerical rating scalle ，NRS），术中知晓、恶心呕吐发生率及喂奶和胃肠功能恢复情况。结果 三组新生儿娩出的Apgar评分、NBNA评分无统计学差异，且脐动脉血气分析指标均在正常范围；产妇术后1h NRS三组有统计学差异但无临床意义，肠道恢复通气时间和开始哺乳时间，三组无显著差异。结论 喉罩用于全麻剖宫产对母婴是安全的，对产妇术后恢复也无不良影响。 【关键词】: 剖宫产术；全身麻醉；硬膜外麻醉；蛛网膜下腔麻醉；喉罩 The comparison of laryngeal mask airway anesthesia ,epidural anesthesia and spinal anesthesia for cesarean section . SONG Cundi,QIU Yimin,HUANG Xiaojing,ZHU Hui,WANG Zhengping.Department of Anesthesiology,First People’s Hosital,Shanghai Jiaotong University,Shanghai 200080,China 【Abstract】Objective Comparing the impact of laryngeal mask ventilation anesthesia, epidural anesthesia and spinal anesthesia on neonatal and maternal postoperative recovery.Methods Ninty parturients who would have elective cesarean sections were divided into general anesthesia —————————————————— 作者单位：200080 1、上海交通大学附属第一人民医院麻醉科（宋村笛现在上海交通大学附属第九人民医院麻醉科基地住院医师）2、上海交通大学附属第一人民医院疼痛科 通信作者：汪正平，电子邮箱为wangzpli@ group,epidural anesthesia group and the spinal anesthesia group . General anesthesia was induced with vecuronium 0.05mg/kg, ketamine 30~40mg, propofol 1.0mg/kg, succinylcholine 1.5 mg/kg.The parturient was intubated with a LMA. Sevoflurane 1.0%-1.5 % in oxygen was administered to maintain anesthesia. After delivery, midazolam , fentanyl and Tramal was injected. We collected arterial samples from the umbilical cord segment at delivery for arterial blood gas analysis and recorded the Appger scores at 1min and 5min of all newborns and the neonatal behavioral neurological assessment (NBNA) 1d ,2d, 3d and 5d after birth. All parturients were observed: whether maternal supine hypotension happened; whether