Shyken J M, Smeltzer J S, Baxi L V, Blakemore K J, Ambrose S E, Petrie R H
Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63112.
Am J Obstet Gynecol. 1990 Sep;163(3):802-7. doi: 10.1016/0002-9378(90)91072-k.
The effect of epidural anesthesia on neonatal acid-base status, before, during, and after labor, was determined by review of funic blood-gas values from 142 women with normal term pregnancies and normal fetal heart rate patterns. Funic acid-base parameters were compared by type of anesthesia when stratified by mode of delivery (vaginal, cesarean section in the active phase of labor, or elective cesarean section). Use of epidural analgesia for vaginal delivery was associated with significantly longer labor, lower umbilical arterial pH, higher arterial PCO2 and arterial bicarbonate values. In women who had cesarean section in the active phase of labor, use of epidural anesthesia was associated with significantly lower arterial and venous PO2 values when compared with women who received general anesthesia. Patients who had elective cesarean section with epidural anesthesia had funic acid-base values similar to women who had general anesthesia. Epidural analgesia-anesthesia offers no clear advantage to the uncompromised term fetus.
通过回顾142例足月妊娠且胎儿心率模式正常的妇女的脐血血气值,确定了分娩前、分娩期间和分娩后硬膜外麻醉对新生儿酸碱状态的影响。当按分娩方式(阴道分娩、产程活跃期剖宫产或择期剖宫产)分层时,根据麻醉类型比较脐部酸碱参数。阴道分娩使用硬膜外镇痛与产程显著延长、脐动脉pH值降低、动脉PCO2和动脉碳酸氢盐值升高有关。在产程活跃期行剖宫产的妇女中,与接受全身麻醉的妇女相比,使用硬膜外麻醉与动脉和静脉PO2值显著降低有关。接受硬膜外麻醉的择期剖宫产患者的脐血酸碱值与接受全身麻醉的妇女相似。硬膜外镇痛麻醉对未受影响的足月胎儿没有明显优势。