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优化剖宫产新生儿结局:全身麻醉与脊髓麻醉下应激指标的比较分析

Optimizing Newborn Outcomes in Cesarean Sections: A Comparative Analysis of Stress Indicators under General and Spinal Anesthesia.

作者信息

Uram-Benka Anna, Fabri-Galambos Izabella, Pandurov-Brlić Marina, Rakić Goran, Bošković Nikola, Uram-Dubovski Jasminka, Antić Jelena, Dobrijević Dejan

机构信息

Institute for Children and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia.

Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia.

出版信息

Children (Basel). 2024 Jun 27;11(7):783. doi: 10.3390/children11070783.

DOI:10.3390/children11070783
PMID:39062232
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11276436/
Abstract

BACKGROUND AND OBJECTIVES

The moment of birth represents a complex physiological process that is followed by adaptive changes in the vital systems of the newborn. Such reactions have their positive but also negative effects. The aim of this research was to determine the difference in laboratory values of stress indicators in newborn children delivered by cesarean section (CS) with general and spinal anesthesia. We attempted to make a recommendation about the optimal type of anesthesia based on our results.

MATERIALS AND METHODS

The study was performed on 150 healthy term newborns delivered by urgent or planned CS. Samples for adrenocorticotropic hormone (ACTH), cortisol, triglycerides, and interleukin-6 (IL-6) were analyzed.

RESULTS

Leukocyte numbers, triglycerides, and blood sugar values were normal for the newborns' age, with statistically significantly lower values of blood sugar and triglycerides in newborns delivered by CS in spinal anesthesia ( < 0.005) compared to general anesthesia. There were no significant differences in ACTH, cortisol, and IL-6 levels between those newborns delivered via CS after spinal or general anesthesia.

CONCLUSIONS

In cases where vaginal delivery is not possible, when CS is indicated, the use of well-controlled spinal anesthesia is followed by lower degrees of metabolic, inflammatory, and stress responses and better vitality of the baby upon birth.

摘要

背景与目的

出生时刻代表着一个复杂的生理过程,随后新生儿的重要系统会发生适应性变化。这些反应既有积极影响,也有消极影响。本研究的目的是确定在剖宫产(CS)时接受全身麻醉和脊髓麻醉的新生儿应激指标实验室值的差异。我们试图根据研究结果就最佳麻醉类型提出建议。

材料与方法

对150例通过紧急或计划剖宫产分娩的足月健康新生儿进行了研究。分析了促肾上腺皮质激素(ACTH)、皮质醇、甘油三酯和白细胞介素-6(IL-6)的样本。

结果

新生儿的白细胞数量、甘油三酯和血糖值与其年龄相符,脊髓麻醉下剖宫产出生的新生儿血糖和甘油三酯值在统计学上显著低于全身麻醉下剖宫产出生的新生儿(<0.005)。脊髓麻醉或全身麻醉后剖宫产出生的新生儿之间,ACTH、皮质醇和IL-6水平无显著差异。

结论

在无法进行阴道分娩而需要剖宫产的情况下,使用控制良好的脊髓麻醉后,新生儿的代谢、炎症和应激反应程度较低,出生时活力更好。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddb8/11276436/f3273cb0e774/children-11-00783-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddb8/11276436/46cc885c2a26/children-11-00783-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddb8/11276436/f3273cb0e774/children-11-00783-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddb8/11276436/46cc885c2a26/children-11-00783-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddb8/11276436/f3273cb0e774/children-11-00783-g002.jpg

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Preterm Birth and Corticotrophin-Releasing Hormone as a Placental Clock.早产与促肾上腺皮质激素释放激素:胎盘的时钟。
Endocrinology. 2022 Dec 19;164(2). doi: 10.1210/endocr/bqac206.
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Altered Cord Blood Lipid Concentrations Correlate with Birth Weight and Doppler Velocimetry of Fetal Vessels in Human Fetal Growth Restriction Pregnancies.在人类胎儿生长受限妊娠中,改变的脐血脂质浓度与胎儿血管的出生体重和多普勒流速有关。
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