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目的比较不同麻醉方法用于剖宫产手术中对新生儿氧摄取率(ERO_2)的影响。方法选择40例行子宫下段剖宫产手术的足月产妇,有椎管内麻醉禁忌证者纳入丙泊酚复合雷米芬太尼全身麻醉组(GA组,20例),无椎管内麻醉禁忌证者纳入硬膜外麻醉组(EA组,20例)。比较两组麻醉开始至胎儿娩出时间(I-D)、子宫切开至胎儿娩出时间(U-D)、新生儿娩出后的脐动静脉血气分析值、ERO_2、Apgar评分和新生儿神经行为学(NBNA)评分。结果 EA组I-D长于GA组(P<0.05),两组U-D、新生儿脐动静脉血pH值、PO_2、PCO_2、SpO_2、Hb含量及ERO_2均无统计学差异(P>0.05)。GA组新生儿1-min Apgar评分低于EA组(P<0.05),两组5-min Apgar评分无统计学差异(P>0.05)。所有新生儿24h的NBNA评分大于35分。结论丙泊酚复合雷米芬太尼全身麻醉用于剖宫产手术对新生儿的ERO_2影响较小,但应预防新生儿一过性呼吸抑制。
Objective To compare the effects of different anesthesia methods on neonatal oxygen uptake (ERO_2) during cesarean section. Methods A total of 40 full-term pregnant women undergoing cesarean section underwent uterine surgery were enrolled in this study. Contraindications to intraspinal anesthesia were enrolled in the propofol combined remifentanil general anesthesia group (GA group, n = 20) without spinal anesthesia Contraindications were included in the epidural anesthesia group (EA group, 20 cases). The time between onset of anesthesia and fetal delivery (ID), uterine incision to fetal delivery time (UD), umbilical arterial and venous blood gas analysis after delivery, ERO_2, Apgar score and neonate neurobehavioral score (NBNA) . Results The I-D in EA group was longer than that in GA group (P <0.05). There was no significant difference in umbilical arterial blood pH value, PO_2, PCO_2, SpO_2, Hb content and ERO_2 between U-D and neonates. The neonatal 1-minute Apgar score in GA group was lower than that in EA group (P <0.05). There was no significant difference in 5-min Apgar score between the two groups (P> 0.05). NBNA score was greater than 35 for all neonates at 24h. Conclusion Propofol combined remifentanil general anesthesia for caesarean operation has little effect on newborn ERO_2, but should prevent neonatal transient respiratory depression.