發(fā)布時間：2019-06-18 11:59

【摘要】：目的：通過對新生兒臍血pH值及脈搏氧飽和度(Sp02)進行采集并分析,探討低濃度七氟醚密閉吸入輔助硬膜外阻滯對剖宮產(chǎn)新生兒的安全性影響。 方法：選取2011年10月-2012年10月期間的90例因社會因素行剖宮產(chǎn)手術(shù)患者,ASA分級Ⅰ級,隨機分為對照組(A組)和七氟醚組(B組),每組45例。均常規(guī)行硬膜外穿刺置管,成功后注入局麻藥試驗量,測得麻醉平面后,A組密閉面罩吸入相同濃度氧氣而B組吸入研究劑量的七氟醚,兩組均硬膜外常規(guī)用藥。胎兒娩出后取臍血進行血氣分析及乳酸測定,同時記錄新生兒lmin、5min Apgar評分及新生兒動脈氧飽和度(Sp02),進行相關(guān)性分析。 結(jié)果： (1)A組娩出前胎兒心率(bpm)140.1±8.4,娩出后心率為141.2±8.5,波動范圍為1.1±0.1；B組娩出前胎兒心率139.7±7.7,娩出后心率為140.7±8.7,波動范圍為1.0±1.0。兩組相比無顯著性差異(P0.05)。 (2)臍血血氣分析臍動脈血pH測值A(chǔ)組7.26±0.07,B組7.25±0.07,兩組相比無顯著性差異(P0.05)；B組臍靜脈血的pH值為7.30±0.08,略低于A組的7.32±0.06,但亦無顯著性差異(P0.05)。 (3)新生兒Apgar評分A組分別為lmin時8.9±1.8(分),5min時9.5±1.5；B組分別為lmin時8.8±2.8,5min時9.2±1.1。兩組相同時間點之間比較無顯著性差異(P0.05)。 (4)Sp02(%)A組分別為lmin時97.5±3.5,5min時98.2±4.4；B組分別為imin時97.2±4.5,5min時98.5±3.6。兩組相同時間點之間比較無顯著性差異(P0.05)。 (5)手術(shù)開始到胎兒娩出時間(min)A組為8.8±1.7,B組為7.1±1.4,兩組差異有統(tǒng)計學(xué)意義(P0.01),即觀察兩組對剖宮產(chǎn)手術(shù)時間方面的影響,B組明顯優(yōu)于A組。 結(jié)論：應(yīng)用劑量七氟醚作為硬膜外麻醉下行剖宮產(chǎn)術(shù)的輔助吸入用藥,與非應(yīng)用組對比效果確切(縮短了胎兒剖出時間及手術(shù)時間),從Apgar評分、臍血pH值及Sp02監(jiān)測等多個生命指標(biāo)觀察無顯著性差異,即對新生兒無明顯不良反應(yīng),為剖宮產(chǎn)手術(shù)麻醉方式提供了更多選擇。
[Abstract]:Objective: to investigate the safety of cord blood pH value and pulse oxygen saturation (Sp02) in neonates undergoing cesarean section by collecting and analyzing the pH value and pulse oxygen saturation (PBO) of neonatal umbilical cord blood and exploring the safety of low concentration sevoflurane closed inhalation assisted epidural block. Methods: from October 2011 to October 2012, 90 patients undergoing cesarean section due to social factors were randomly divided into control group (group A) and sevoflurane group (group B) with 45 cases in each group. All the patients were given epidural puncture and catheterization, and the local anesthetic test was injected successfully. After the anesthesia plane was measured, the closed mask in group A inhaled the same concentration of oxygen, while group B inhaled sevoflurane in the study dose, and both groups were given routine epidural medication. Umbilical cord blood was taken for blood gas analysis and lactic acid determination after delivery. Neonatal lmin,5min Apgar score and neonatal arterial oxygen saturation (Sp02) were recorded for correlation analysis. Results: (1) in group A, the fetal heart rate was 140.1 鹵8.4 before delivery, 141.2 鹵8.5 after delivery, and the fluctuation range was 139.7 鹵7.7 in group B, 140.7 鹵8.7 and 1.0 鹵1.0 in group B before delivery. There was no significant difference between the two groups (P 0.05). (2) there was no significant difference in umbilical artery blood pH between group A (7.26 鹵0.07) and group B (7.25 鹵0.07). There was no significant difference between the two groups (P 0.05). The pH value of umbilical vein blood in group); B was 7.30 鹵0.08, which was slightly lower than that in group A (7.32 鹵0.06), but there was no significant difference between the two groups (P 0.05). (3) the neonatal Apgar score in group A was 8.9 鹵1.8 at lmin, 9.5 鹵1.5 for 5min, 8.8 鹵2.8 for lmin and 9.2 鹵1.1 at 5 min, respectively. There was no significant difference between the two groups at the same time point (P 0.05). (4) Sp02 (%) A group was 97.5 鹵3.5 at lmin, 98.2 鹵4.4 in group B at 5 min, 97.2 鹵4.5 in group B and 98.5 鹵3.6 at 5 min, respectively. the results showed that lmin was 97.5 鹵3.5 in group A, 98.2 鹵4.4 in group B at 5 min, and 98.5 鹵3.6 in group B at 5 min. There was no significant difference between the two groups at the same time point (P 0.05). (5) the time from the beginning of operation to fetal delivery was 8.8 鹵1.7 in (min) A group and 7.1 鹵1.4 in group B. There was significant difference between the two groups (P 0.01). The effect of the two groups on the operation time of cesarean section was significantly better in group B than in group A. Conclusion: the application of sevoflurane as auxiliary inhaled drug for cesarean section under epidural anesthesia is effective compared with the non-application group (shortening the time of fetal caesarean section and operation time). There is no significant difference in Apgar score, umbilical cord blood pH value and Sp02 monitoring, that is to say, there is no obvious adverse reaction for neonates, which provides more options for anesthesia of cesarean section.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R614

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