摘要
目的探讨两种不同麻醉方法对剖宫产产妇母脐血中缺血修饰蛋白（IMA）水平的影响。方法选择2011年1月至2013年12月潍坊市人民医院行剖宫产的64例产妇为研究对象。按照随机数字表法分为A组和B组,各32例。A组术中给予全身麻醉,静脉注射（注射时间≥1 min）瑞芬太尼1 pg/kg,30 s后依次静脉注射丙泊酚1.5 mg/kg和阿曲库铵0.6 mg/kg,气管插管后行机械通气;B组术中给予腰硬联合麻醉,麻醉前静脉滴注羟乙基淀粉130/0.4 0.9%NaCl注射液8~10 mL/kg,蛛网膜下腔用药为0.5%布比卡因10 mg,留置硬膜外导管以备术中追加麻醉药物。检测两组术前、术中30 min母血IMA、母血白蛋白水平,检测两组脐血IMA、脐血白蛋白水平,比较两组术前、术中30 min母血IMA/母血白蛋白、脐血IMA/脐血白蛋白比值。结果 A组术中30 min母血IMA水平较术前显著升高[（4.6±0.8）μg/L比（4.0±0.8）μg/L]（P〈0.05）,而B组术前、术中母血IMA水平比较差异无统计学意义（P〉0.05）;A组和B组术中30 min母血白蛋白水平均较术前下降[（24.2±6.2）g/L比（29.1±7.1）g/L,（24.5±6.5）g/L比（28.8±6.9）g/L]（P〈0.05）。A组术中30 min母血IMA/白蛋白比值较术前增加[（1.9±0.8）比（1.4±0.6）]（P〈0.05）,而B组术前、术中母血IMA/白蛋白比较差异无统计学意义（P〉0.05）;A组脐血IMA水平、脐血IMA/白蛋白比值高于B组[（3.7±0.7）μg/L比（3.2±0.6）μg/L,（1.3±0.4）比（1.0±0.4）],差异有统计学意义（P〈0.05）,A组和B组脐血白蛋白水平比较差异无统计学意义（P〉0.05）;母血IMA水平与脐血IMA水平呈正相关（r=0.069,P=0.011）;母血IMA水平与母血白蛋白水平呈负相关（r=-0.058,P=0.017）;脐血IMA水平与脐血白蛋白水平呈负相关（r=-0.051,P=0.026）。结论 IMA为反映机体氧化应激反应的敏感指标,不同麻醉方法对剖宫产产妇母脐血中IMA水平的影响存在一定的差异,该差异可能与
Objective To study the effect of two anesthesia techniques on maternal and cord blood ischemia-modified albumin（ IMA） levels during cesarean section. Methods From Jan. 2011 to Dec. 2013,64 cases of pregnant women with Cesarean section in Weifang People’s Hospital were included in the study.The 64 patients were divided into group A and group B according to random number table method,32 cases each. Group A was given general anesthesia,intravenous injection（ injection time ≥1 min） of remifentanil,1 pg / kg,followed by intravenous injection of propofol 1. 5 mg / kg and atracurium 0. 6 mg / kg after 30 s,then was given intubation for mechanical ventilation; group B was given epidural anesthesia,intravenous anesthesia before hydroxyethyl starch 130 /0. 4 0. 9% NaCl injection 8-10 mL / kg,subarachnoid administration of 0. 5% bupivacaine 10 mg,indwelling epidural catheter to prepare for additional local anesthesia during operation. The preoperative,30 min intraoperative maternal IMA,maternal serum albumin level,the umbilical cord blood IMA and serum albumin levels ofthe two groups were detected,and the preoperative and 30 min intraoperative maternal IMA / maternal blood albumin,umbilical cord blood IMA / umbilical cord blood albumin ratio of the two groups were compared. Results The 30 min intraoperative maternal serum IMA level in group A was significantly increased than before operation[（ 4. 6 ± 0. 8） μg / L vs（ 4. 0 ± 0. 8） μg / L]（ P 〈0. 05）,and no significant difference in IMA levels in maternal blood of group B before operation from 30 min intraoperative（ P 〉 0. 05）; maternal blood albumin levels in both groups were decreased [（ 24. 2 ± 6. 2） g / L vs（ 29. 1 ± 7. 1） g / L,（ 24. 5 ± 6. 5） g / L vs（ 28. 8 ± 6. 9） g / L]（ P 〈 0. 05）. 30 min intraoperative maternal IMA / albumin ratio in group A was increased than before operation[（ 1. 9 ± 0. 8） vs（ 1. 4 ± 0. 6） ]（ P 〈0. 05）,while no significant differences in group B between preoperative and
出处
《医学综述》
2016年第7期1430-1433,共4页
Medical Recapitulate
关键词
剖宫产
麻醉
缺血修饰蛋白
白蛋白
氧化应激反应
Cesarean section
Anesthesia
Ischemia modified albumin
Albumin
Oxidative stress
