瑞芬太尼用于精神分裂症产妇剖宫产对母婴的影响#br#

doi:10.3969/j.issn.10073205.2018.03.020

摘要/Abstract

摘要： ［摘要］〓
〖HTH〗目的〖HTSS〗〖KG*2〗探讨瑞芬太尼在精神分裂症产妇靶控输注中的最合适浓度以及对母婴的影响。
〖HTH〗方法〖HTSS〗〖KG*2〗择期全身麻醉下行剖宫产术精神分裂症初产妇60例，随机均分为低剂量组（瑞芬太尼2.0 μg/L）、中剂量组（瑞芬太尼3.0  μg/L）和高剂量组（瑞芬太尼4.0 μg/L）。靶控输注瑞芬太尼至目标血浆靶控浓度，异丙酚2.0 mg/kg 静脉注射，罗库溴铵0.6 mg/kg 静脉注射，行气管插管术。记录麻醉诱导前（T1）、气管插管后即刻（T2）、切皮时（T3）、胎儿娩出前即刻（T4）及关腹时（T5）产妇的收缩压（systolic blood pressure,SBP）、舒张压（diastolic blood pressure,DBP）和心率（heart rate,HR）。记录手术时间、异丙酚用量、术后呼之睁眼时间和拔管时间。分别于出生后1 min和5 min记录新生儿Apgar评分，并记录出生后1 h、24 h新生儿行为神经测定评分。
〖HTH〗结果〖HTSS〗〖KG*2〗与T1比较，低剂量组收缩压、舒张压和心率在T2、T3、T4和T5呈逐渐升高趋势，中剂量组和高剂量组SBP、DBP和HR呈逐渐下降趋势，但在T3和T4有小的波动， 3组SBP和HR在组间、组间·时点间交互作用差异均有统计学意义（P＜005）,而3组DBP在组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜005）。中剂量组和高剂量组较低剂量组睁眼时间和拔管时间长，高剂量组又较中剂量组拔管时间长，高剂量组异丙酚用量较低剂量组和中剂量组少，差异均有统计学意义(P＜005)。高剂量组新生儿出生后1 min、5 min Apgar评分及出生后1 h、24 h新生儿行为神经测定评分较低剂量组和中剂量组低(P＜005)。中剂量组和高剂量组产妇桡动脉、新生儿脐静脉中瑞芬太尼血药浓度较低剂量组增高(P＜005)；高剂量组产妇桡动脉、新生儿脐静脉中瑞芬太尼血药浓度较中剂量组增高(P＜005)。中剂量组和高剂量组新生儿脐动脉中瑞芬太尼血药浓度高于低剂量组，中剂量组、高剂量组新生儿脐动脉瑞芬太尼浓度/产妇桡动脉瑞芬太尼浓度比值高于低剂量组，高剂量组新生儿脐动脉新生儿行为神经测定/新生儿脐静脉瑞芬太尼浓度比值低于低剂量组，差异均有统计学意义(P＜005)。
〖HTH〗结论〖HTSS〗〖KG*2〗瑞芬太尼与异丙酚联合用药具有协同作用。随着瑞芬太尼剂量的增大，其通过胎盘进入胎儿体内的剂量增大，精神分裂症产妇行剖宫产术瑞芬太尼的合适血浆靶控浓度为3.0 μg/L。

关键词: 精神分裂症, 剖宫产术, 瑞芬太尼

Abstract: ［Abstract］ Objective〖HTSS〗〓To explore the most appropriate concentration of remifentanil targeted infusion in schizophrenia pregnant women underwent cesarean delivery and the impact on mothers and babies.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Selected 60 cases of general anesthesia cesarean section schizophrenia primipara were randomly divided into lowdose group(remifentanil 2.0 μg/L), middledose group(remifentanil 3.0 μg/L) and highdose group(remifentanil 4.0 μg/L). With tracheal intubation, remifentanil is administered to target plasma concentrations, with propofol 2.0 mg/kg intravenously, rocuronium 0.6 mg/kg intravenously. The following parameters were recorded: the systolic blood pressure before the induction of anesthesia(T1), immediately after tracheal intubation(T2), incision(T3), immediately before the baby was delivered(T4)，closing the abdomen(T5), systolic arterial pressure(SBP), diastolic blood pressure(DBP) and heart rate(HR), the operation time and the amount of propofol, the recovery time and extubation time at the end of surgery. The Apgar scores of 1 min and 5 min neonates after birth and neonatal neurobehavioral score of 1 h and 24 h were recorded respectively.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓Compared with T1, systolic blood pressure, diastolic blood pressure and heart rate were increased gradually at T2, T3, T4 and T5 in lowdose group, while SBP, DBP and HR were decreased gradually in middledose and highdose groups, but there was a small fluctuation in T3 and T4. There were significant differences in the SBP and HR in the three groups and among intergroups·time interaction(P＜005). However, there were significant differences in the DBP interaction in the three groups, time points and intergroups·time interaction(P＜005). The middledose group and highdose group had longer eye opening time and extubation time than those in the lowdose group, the extubation time was longer in the highdose group than that in the middledose group, The dosage of propofol in the highdose group was lower than that in the lowdose group and middledose group, the difference was statistically significant(P＜005). The neonatal 1 min and 5 min Apgar scores after birth and the neonatal behavioral neurological assessmen scores at 1 h and 24 h after birth in highdose group were lower than that in the lowerdose and middledose groups(P＜005). Remifentanil blood concentration(remifentanil) in maternal radial artery and neonatal umbilical vein in the middledose group and the highdose group were higher than that in the lowdose group(P＜005). Remifentanil in maternal radial artery and neonatal umbilical vein in highdose group were higher than that in the middledose group(P＜005). Rremifentanil in neonatal umbilical artery in the middledose group and highdose group was higher than that in the lowdose group. Remifentanil ratio of neonatal umbilical artery/maternal radial artery in the middledose group and highdose group was higher than the lowdose group, remifentanil ratio of neonatal umbilical artery/neonatal umbilical vein in highdose group was lower than the lowdose group, the difference was statistically significant(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Remifentanil combined with propofol has a synergistic effect. As the dose of remifentanil increases, the dose of remifentanil increases through the placenta into the fetus. The appropriate plasma target concentration for remifentanil is 3.0 μg/L for schizophrenia pregnant women underwent cesarean section.

Key words: schizophrenia; , cesarean section, remifentanil

王〓欣1，王〓莉1，高金贵2*. 瑞芬太尼用于精神分裂症产妇剖宫产对母婴的影响#br#[J]. 河北医科大学学报, doi: 10.3969/j.issn.10073205.2018.03.020.

WANG Xin1, WANG Li1, GAO JinGui2*. The effect of remifentanil on mother and infant used in cesarean section of schizophrenic women#br#[J]. Journal of Hebei Medical University, doi: 10.3969/j.issn.10073205.2018.03.020.

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瑞芬太尼用于精神分裂症产妇剖宫产对母婴的影响#br#

The effect of remifentanil on mother and infant used in cesarean section of schizophrenic women#br#

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