【罂粟摘要】择期剖宫产中两种不同剂量的硫喷妥钠对产妇麻醉深度充分性的影响:一项随机临床试验
择期剖宫产中两种不同剂量的硫喷妥钠对产妇麻醉深度充分性的影响:一项随机临床试验
贵州医科大学 高鸿教授课题组
翻译：张中伟 编辑：佟睿 审校：曹莹
在剖宫产术中，给予最佳剂量的麻醉剂以确保足够的麻醉深度，同时避免对胎儿产生不良影响是非常重要的。在一些国家，硫喷妥钠仍然是产科手术麻醉诱导的首选药物。我们的研究目的是比较两种不同剂量的硫喷妥纳对产妇麻醉深度和新生儿状况的影响。
在这项临床试验中，我们把接受择期剖宫产术的产妇随机分为两组，分别接受低剂量(5mg/kg)和高剂量(7mg/kg)的硫喷妥钠。选用2mg/kg琥珀胆碱作肌肉松弛剂，用O2/N2O和七氟醚进行维持麻醉。在不同阶段，使用孤立前臂技术(IFT)和脑电双频指数(BIS)评估麻醉深度。此外，使用Apgar评分和神经行为测试对婴儿健康状况进行评估。
每组有40名产妇接受评估，高剂量组在分娩前切开皮肤时、皮肤缝合时BIS显著降低。此外，在孤立前臂技术的使用中，两组产妇诱导后切皮时和分娩时作出的回应也存在显著差异。分娩1分钟后，高剂量组新生儿的Apgar评分明显降低。低剂量组新生儿在神经行为测试的三个领域结果都显著较好。
7mg/kg的硫喷妥钠可以为母亲创造更深层次镇静的效果，作用优于5mg/kg浓度的硫喷妥钠。但是，它对新生儿的Apgar评分和神经行为测试结果有负面影响。作为剖宫产术中可使用的麻醉剂，硫喷妥钠似乎已经过时了。
Golnar Sabetian, Farid Zand, Fatemeh Mirhadi，et al. Adequacy of maternal anesthesia depth with two sodium thiopental doses in elective caesarean section: a randomized clinical trial.[J]. BMC Anesthesiology (2021) 21:201:1.
Adequacy of maternal anesthesia depth with two sodium thiopental doses in elective caesarean section: a randomized clinical trial
Abstract
Background:Administration of an optimal dose of anesthetic agent to ensure adequate depth of hypnosis with the lowest risk of adverse effects to the fetus is highly important in cesarean section. Sodium thiopental (STP) is still the first choice for induction of anesthesia in some countries for this obstetric surgery. We aimed to compare two doses of STP with regarding the depth of anesthesia and the condition of newborn infants.
Methods: In this clinical trial, parturient undergoing elective Caesarian section were randomized into two groups relaxation was provided with succinylcholine 2 mg/kg and anesthesia was maintained with O2/N2O and sevoflurane. The depth of anesthesia was evaluated using isolated forearm technique (IFT) and bispectral index (BIS) in various phases. Additionally,infants were assessed using Apgar score and neurobehavioral test.
Results: Forty parturient were evaluated in each group. BIS was significantly lower in high-dose group at skin incision to delivery and subcutaneous and skin closure. Also, significant differences were noticed in IFT over induction to incision and incision to delivery. Apgar score was significantly lower in high-dose group at 1 min after delivery. Newborn infants in low-dose group had significantly better outcomes in all three domains of the neurobehavioral test.
Conclusion: 7 mg/kg STP is superior to 5 mg/kg in creating deeper hypnosis for mothers. However, it negatively impacts Apgar score and neurobehavioral test of neonates. STP seems to has dropped behind as an acceptable anesthetic in Cesarean section.
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