Kolatat T, Somboonnanonda A, Lertakyamanee J, Chinachot T, Tritrakarn T, Muangkasem J
Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 1999 Jan;82(1):40-5.
Anesthetic methods used during cesarean section have advantages and disadvantages to both mothers and infants and may result in short and long term neonatal effects.
To determine the effects of general and regional anesthesia on the infants, a prospective, randomized trial was performed in Siriraj Hospital, Mahidol University.
341 uncomplicated pregnant women who were to be delivered at term by Cesarean section were recruited and randomized to receive general anesthesia, GA (103); epidural anesthesia, EA (120) and spinal anesthesia, SA (118). The immediate fetal and neonatal effects were assessed by cord blood gas analysis and the infant's Apgar scores. The Neurologic and Adaptive Capacity Scores (NACS) was performed within 4 hours after birth by two pediatricians who were blind to the anesthetic method.
Maternal age, weight, height, duration of the operation and infants' birth weight were not different among the study groups. In the EA and SA group, maternal systolic blood pressure decreased more than 20 per cent from the baseline in more than half. The infants' Apgar scores at 1 and 5 minutes were 8.3 +/- 1.9; 8.2 +/- 1.6; 6.7 +/- 2.8, and 9.7 +/- 0.9; 9.8 +/- 0.7; 9.2 +/- 1.6 in EA, SA and GA group respectively. The adaptive capacity, active tone, passive tone, general assessment and primary reflexes of the NACS were not statistically different.
Apgar scores of the infants whose mothers received general anesthesia were lower than infants whose mothers received regional anesthesia but the NACS were not statistically different among the three study groups.
剖宫产术中使用的麻醉方法对母亲和婴儿都有优缺点，并且可能导致短期和长期的新生儿影响。
为了确定全身麻醉和区域麻醉对婴儿的影响，在玛希隆大学诗里拉吉医院进行了一项前瞻性随机试验。
招募341例足月行剖宫产的无并发症孕妇，并随机分为接受全身麻醉（GA，103例）、硬膜外麻醉（EA，120例）和蛛网膜下腔麻醉（SA，118例）。通过脐血气分析和婴儿阿氏评分评估即刻胎儿和新生儿影响。出生后4小时内由两位对麻醉方法不知情的儿科医生进行神经和适应能力评分（NACS）。
研究组间产妇年龄、体重、身高、手术时间和婴儿出生体重无差异。在EA组和SA组中，超过半数产妇收缩压较基线下降超过20%。EA组、SA组和GA组婴儿1分钟和5分钟时的阿氏评分分别为8.3±1.9、8.2±1.6、6.7±2.8以及9.7±0.9、9.8±0.7、9.2±1.6。NACS的适应能力、主动肌张力、被动肌张力、总体评估和原始反射无统计学差异。
母亲接受全身麻醉的婴儿阿氏评分低于母亲接受区域麻醉的婴儿，但三个研究组间NACS无统计学差异。
