剖宫产术前应用曲马多对胎儿和新生儿的影响

EFFECT OF DIFFERENT DOSES OF PREOPERATIVE TRAMADOL ON FETUS AND NEWBORNS

摘要:

目的 :探讨剖宫产术前应用不同剂量曲马多对胎儿和新生儿的影响。方法 :6 0例产妇依麻醉前用药不同随机分为三组 :T0 组 (肌注 0 .9%NaCl 2ml)、T1组 (肌注曲马多 1.5mg/kg)、T2 组(肌注曲马多 2mg/kg)。均采用脊麻与硬膜外联合阻滞。术中观察指标 :肌注曲马多至胎儿娩出时间 (DDI) ;子宫切开至胎儿娩出时间 (U D) ;新生儿出生后 1分钟和 5分钟的Apgar评分 ;胎儿脐动、静脉血气分析 ;新生儿出生后 15分钟和 2小时的神经行为和适应能力评分 (NACS)。结果 :DDI、U D和Apgar评分各组间无明显差异 ;出生后 15分钟T2 组NACS中觉醒度和哭叫反应各项2分的百分率均明显低于T0 组 (P <0 .0 5 ) ,出生后 2小时各组间的NACS无明显差异 ;T2 组脐动、静脉血中SaO2 明显低于T0 组 (P <0 .0 5 )而PCO2 明显高于T0 (P <0 .0 1) ;T1组和T2 组各项指标均无显著性差异。结论 :剖宫产术前肌注 1.5mg/kg曲马多对胎儿和新生儿无负面影响 ,2mg/kg曲马多肌注对新生儿神经行为和适应能力评分有一过性影响 ,并且有呼吸抑制作用 ,在剖宫产术中宜慎重使用。

Abstract:

Objective:To study the effect of different doses of Tramadol preoperatively on the fetus and newborns. Methods:Sixty healthy parturients scheduled for elective cesarean section under combined spinal epidural anesthesia were randomly divided into three groups according to the different dose of Tramadol used before anesthesia. Group T 0 (0.9% NaCl 2ml i.m.); Group T 1 (Tramadol 1.5mg/kg i.m.); Group T 2 (Tramadol 2mg/kg i.m.). Intraoperative observed parameters included: DDI (time difference between the intramuscular administration of Tramadol and the time of delivery ), U D (the time difference between the incision of uterus and the delivery time),1 min and 5 min Apgar scores, the umbilical arterial and venous blood gas values, Neonatal neurologic and Adaptive Capacity Scores(NACS)were assessed at 15min and 2 hour after birth. Results :(1)There were no significant differences in Apgar scores at 1min and 5min among three groups. (2)The percentages of infants who scored 2 for Alertness and Crying of the NACS were significantly lower in group T 2 than that in group T 0 at 15min of age( P <0.05); there were no differences between groups at 2 hours of age.(3)The umbilical arterial and venous blood SaO 2 were lower( P <0.05), whereas PaCO 2 were higher( P <0.01)in group T 2 than that in group T 0, and the umbilical venous PaCO 2 in group T 1 was also higher than that in group T 0. Conclusions:Tramadol administration 1.5mg/kg intramascularly in preoperatively has no side effect on fetus and newborns; 2mg/kg Tramadol intramascularly has transient side effect on NACS and respiratory depression, and should be used cautiously during cesarean section.