Evans C M, Murphy J F, Gray O P, Rosen M
Department of Child Health, University of Wales College of Medicine, Cardiff.
Anaesthesia. 1989 Sep;44(9):778-82. doi: 10.1111/j.1365-2044.1989.tb09271.x.
Elective Caesarean section deliveries over a 5-year period were studied to compare the effect of epidural block with general anaesthesia on the condition of the infant at birth. The Apgar score and umbilical arterial acid-base status were used as determinants of the latter. Epidural block was used in 139 (22.8%) mothers while 471 (77.2%) were performed under general anaesthesia. No babies in the epidural group were severely depressed (Apgar less than 4), compared with 6.2% in the general anaesthesia group. Only 4.3% of the epidural sections were moderately depressed (Apgar 4-6), compared with 15.4% of the others. These differences remained highly significant when infants of less than 2500 g were excluded, and when matched groups were compared. Mean umbilical arterial pH was similar within the two groups (pH 7.28), and was not consistent with asphyxia in almost 90% of the depressed infants. The findings suggest that general anaesthesia, rather than asphyxia or aortocaval compression, is responsible for most of the depressed infants born by elective Caesarean section. This may involve over 20% of babies delivered in this manner, so greater use of epidural block for elective Caesarean section is recommended. Further investigations are required to improve results with general anaesthesia.
对5年内择期剖宫产分娩情况进行了研究，以比较硬膜外阻滞和全身麻醉对出生时婴儿状况的影响。采用阿氏评分和脐动脉酸碱状态作为衡量后者的指标。139名（22.8%）母亲采用硬膜外阻滞，而471名（77.2%）在全身麻醉下进行手术。硬膜外阻滞组没有婴儿严重抑制（阿氏评分低于4分），而全身麻醉组为6.2%。硬膜外阻滞组只有4.3%的婴儿中度抑制（阿氏评分4 - 6分），而其他组为15.4%。当排除体重低于2500克的婴儿以及比较配对组时，这些差异仍然非常显著。两组的平均脐动脉pH值相似（pH 7.28），并且在几乎90%的抑制婴儿中与窒息情况不符。研究结果表明，全身麻醉而非窒息或主动脉腔静脉压迫是择期剖宫产出生的大多数抑制婴儿的原因。这可能涉及以这种方式分娩的超过20%的婴儿，因此建议在择期剖宫产中更多地使用硬膜外阻滞。需要进一步研究以改善全身麻醉的效果。
