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目的:观察胎儿窘迫产妇术前不同方式给予纳洛酮对剖宫产新生儿的影响,选择一种预防新生儿窒息更有效的给药方式。方法:选择满足手术条件的胎儿窘迫产妇499例,随机分为两组。观察组(n=216)术前4～6 h静脉滴入0.1 mg/mg纳洛酮,间隔0.5～1 h重复1～2次;治疗组(n=233)术前4～6 h泵注纳洛酮8 mg至胎儿剖出,速度为8 ml/h。新生儿剖出未呼吸前夹脐带两端,抽取脐动脉血3 ml做血气分析。同时对新生儿进行即刻Apgar评分,两组Apgar评分8～10分、4～7分、0～3分各段随机采集10例新生儿脐静脉血4 ml,测血浆β-EP水平。结果:两组新生儿剖出即刻正常和轻度窒息率无统计学差异(P>0.05),重度窒息新生儿数观察组比治疗组高(χ2=6.280,P=0.013)。治疗组新生儿酸中毒症状轻,脐动脉血气pH、PaCO2、PaO2、HCO3-值优于观察组(P<0.05)。正常和轻度窒息新生儿脐静脉血β-EP水平两组无统计学差异(P>0.05),重度窒息新生儿脐静脉血β-EP水平观察组明显高于治疗组(P<0.05)。随着新生儿窒息程度减轻,脐静脉血β-EP水平降低。两种方式给药后,显效新生儿数治疗组明显高于观察组(χ2=5.402,P=0.023);有效新生儿数两组无统计学差异(χ2=3.789,P=0.064),无效率观察组比治疗组高(χ2=6.230,P=0.018)。结论:胎儿窘迫产妇术前4～6 h纳洛酮持续泵注比多次静脉滴入更能有效预防新生儿窒息。
OBJECTIVE: To observe the effect of naloxone on neonatal cesarean section before fetal distress maternal preoperative different ways, choose a more effective way to prevent neonatal asphyxia. Methods: 499 fetuses with fetal distress were selected to meet the surgical conditions and were randomly divided into two groups. In the observation group (n = 216), naloxone 0.1 mg / mg was intravenously dripped 4 to 6 hours before operation and repeated 1 to 2 times every 0.5 to 1 h. The patients in the treatment group (n = 233) Naloxone 8 mg to the fetus sectioned at a speed of 8 ml / h. Neonatal dissection of non-pre-umbilical cord clip both ends of the umbilical artery 3 ml blood gas analysis. At the same time, Apgar score was applied to neonates. Apgar scores of 8 to 10, 4 to 7, and 0 to 3 were used to measure the plasma β-EP level in 10 neonates. Results: There was no significant difference in immediate and mild asphyxia between two groups of newborns (P> 0.05). The number of neonatal asphyxia group was higher than that of the treatment group (χ2 = 6.280, P = 0.013). The treatment group neonatal acidosis symptoms, umbilical arterial blood gas pH, PaCO2, PaO2, HCO3-value was better than the observation group (P <0.05). The levels of β-EP in umbilical venous blood of normal and mild asphyxia neonates had no statistical difference (P> 0.05). The levels of β-EP in umbilical venous blood of neonates with severe asphyxia were significantly higher than those of the treatment group (P <0.05). With the reduction of neonatal asphyxia, umbilical blood β-EP levels decreased. After administration of two ways, the number of effective neonates in the treatment group was significantly higher than that in the observation group (χ2 = 5.402, P = 0.023); there was no significant difference between the two groups (χ2 = 3.789, P = 0.064) The observation group was higher than the treatment group (χ2 = 6.230, P = 0.018). CONCLUSION: Naloxone is safe and effective in preventing neonatal asphyxia after continuous intravenous infusion of naloxone 4 ~ 6 h before fetus distress.