The effect of remifentanil on mother and infant used in cesarean section of schizophrenic women#br#
WANG Xin1, WANG Li1, GAO JinGui2*
2018, 38(3):
330-335.
doi:10.3969/j.issn.10073205.2018.03.020
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［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 lowdose group(remifentanil 2.0 μg/L), middledose group(remifentanil 3.0 μg/L) and highdose 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(T1), immediately after tracheal intubation(T2), incision(T3), immediately before the baby was delivered(T4)，closing the abdomen(T5), 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 T1, systolic blood pressure, diastolic blood pressure and heart rate were increased gradually at T2, T3, T4 and T5 in lowdose group, while SBP, DBP and HR were decreased gradually in middledose and highdose groups, but there was a small fluctuation in T3 and T4. There were significant differences in the SBP and HR in the three groups and among intergroups·time interaction(P＜005). However, there were significant differences in the DBP interaction in the three groups, time points and intergroups·time interaction(P＜005). The middledose group and highdose group had longer eye opening time and extubation time than those in the lowdose group, the extubation time was longer in the highdose group than that in the middledose group, The dosage of propofol in the highdose group was lower than that in the lowdose group and middledose group, the difference was statistically significant(P＜005). 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 highdose group were lower than that in the lowerdose and middledose groups(P＜005). Remifentanil blood concentration(remifentanil) in maternal radial artery and neonatal umbilical vein in the middledose group and the highdose group were higher than that in the lowdose group(P＜005). Remifentanil in maternal radial artery and neonatal umbilical vein in highdose group were higher than that in the middledose group(P＜005). Rremifentanil in neonatal umbilical artery in the middledose group and highdose group was higher than that in the lowdose group. Remifentanil ratio of neonatal umbilical artery/maternal radial artery in the middledose group and highdose group was higher than the lowdose group, remifentanil ratio of neonatal umbilical artery/neonatal umbilical vein in highdose group was lower than the lowdose group, the difference was statistically significant(P＜005).
〖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.
