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喉罩通气全麻剖宫产对母婴影响的临床研究
The clinical study on the effects of general anesthesia with laryngeal mask for cesarean section on mother and newborn
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DOI:
作者:
宋村笛, 裘毅敏,黄小静,朱慧, 汪正平
songcund ,qiuyimin,,wang zhengping
作者单位:
上海交通大学附属第一人民医院麻醉科
First People’s Hosital,Shanghai Jiaotong University
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
Cesarean section;General anesthesia;Epidural anesthesia;Spinal anesthesia;Laryngeal mask
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。
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 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 anesthesia awareness during surgery and laryngeal mask complications occurred. Postoperative follow-up concluded numerical rating scalle (NRS) 1h and 24h after surgury, the conditions of breast-feeding and gastrointestinal function recovery and whether vomiting or bloating happened. Results There was no significant difference among the three groups of the Appgar scores at 1min, 5min and the NBNA 1d, 2d, 3d, 5d . All the neonatal umbilical arterial blood gas analysis were within the normal range. The NRS of the parturients didn't show significant difference among the three groups in 24h, but in 1h, the general anesthesia group was much lower than other groups. There was no significant difference among the three groups of the first breast-feeding time and gastrointestinal function recovery. Conclsion Our study suggested that using laryngeal mask in our general anesthesia program for cesarean section had no significant adverse effects on newborns and maternal postoperative recovery.
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