Objective: To compare the safety of sevoflurane anesthesia with laryngeal mask and tracheal intubation in cesarean section in women with heart disease.
Methods: Fifty-two pregnant women with heart diseases undergoing cesarean section were randomized into laryngeal mask (LAM) group and tracheal intubation group. In LAM group, 6% sevoflurane was given at the rate of 6 L/min for induction with a maintenance sevoflurane concentration of 3%. In the intubation group, 1.5 mg/kg propofol and 1 µg/kg remifentanil were injected intravenously, and after achieving D0 with Narcotrend monitoring, 0.9 mg/kg rocuronium was injected and intubation was performed 1 min later. The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded in the two groups before anesthesia induction (T0), at intubation or laryngeal mask placement (T1), skin incision (T2), and extubation or laryngeal mask removal (T3). The surgery to fetal birth time, uterine incision to fetal childbirth time, drug discontinuation to awake time, and newborn Apgar scores were also recorded. Sevoflurane consumption and maternal comfort during hospitalization were compared between the two groups.
Results: In LAM group, HR and MBP at T1 and T3 were significantly lower than those in the intubation group (P<0.05). The drug discontinuation to extubation time and to awaken time were significantly shorter in LAM group than in the intubation group (P<0.05), but the operation time and fetal child birth time were comparable between the two groups (P>0.05). The women in LAM group reported better physical and psychological comforts than those in the intubation group (P<0.05). The neonatal Apgar scores and the scores of health education, satisfaction with hospital environment and service were all similar between the two groups (P>0.05).
Conclusion: Sevoflurane anesthesia with laryngeal mask can achieve satisfactory anesthetic effects in cesarean section in women with heart disease.
目的: 探讨喉罩下七氟醚吸入全麻在妊娠合并心脏病产妇剖宫产手术中的可行性及安全性。
方法: 52例妊娠合并心脏病的孕妇，ASA Ⅱ~Ⅲ级、心功能Ⅱ~Ⅲ级、择期行剖宫产，随机分为两组：喉罩组和气管插管组。喉罩组以6%七氟醚加6 L/min氧气吸入诱导，七氟醚吸入维持，插管组按异丙酚1.5 mg/kg，瑞芬太尼1 μg/kg推注，Narcotrend脑电监测达到D0水平（常规麻醉状态）注射罗库溴铵0.9 mg/kg，1 min后进行气管插管，七氟醚吸入维持。记录两组产妇麻醉诱导前（T0）、插管（放置喉罩）时（T1）、切皮时（T2）、拔管（喉罩）（T3）各时点收缩压、舒张压、平均动脉压、心率和脑电的变化，手术开始至胎儿娩出时间、切开子宫至胎儿娩出时间、停药至患者清醒时间，新生儿1、5和10 min的Apgar评分，两组产妇七氟醚用量，并对产妇住院期间的舒适度进行统计分析。
结果: 喉罩组插喉罩和拔喉罩时的心率分别为82.17±2.35次/min和82.56±5.83次/min，均明显低于插管组（P < 0.05）；平均动脉压分别为69.89±10.39 mmHg和73.54±11.25 mmHg，明显低于插管组（P < 0.05）；其余各项指标两组差异无统计学意义（P>0.05）。喉罩组产妇停药至拔管时间和苏醒时间分别为5.59±3.15分和7.26±3.21分，明显低于插管组（P < 0.05）；两组产妇手术时间和胎儿娩出时间差异无统计学意义（P>0.05）。新生儿1、5和10 min的Apgar评分两组差异无统计学意义（P> 0.05）。术中维持相同镇静深度，喉罩组产妇七氟醚用量较插管组少，但差异无统计学意义（P>0.05）。喉罩组产妇在生理舒适和心理舒适方面给出的评分分别为74.2±12.4分和69.2±10.1分，均显著高于插管组（P < 0.05）。两组在住院环境、服务态度和健康教育方面的评分方面差异无统计学意义（P>0.05）。
结论: 喉罩下七氟醚吸入全麻在妊娠合并心脏病产妇的剖宫产手术中麻醉效果显著，患者术后舒适度评价较插管的吸入性全麻效果好。