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中华妇幼临床医学杂志(电子版) ›› 2015, Vol. 11 ›› Issue (4) : 448 -453. doi: 10.3877/cma.j.issn.1673-5250.2015.04.003

所属专题： 文献；

论著

胎羊宫内心脏介入手术中孕羊麻醉方案研究
石晓青, 杨晓玲, 赵亮, 李一飞, 王川, 华益民*(), 周开宇*()   
  1. 610041　成都，四川大学华西第二医院儿科；610041　成都，妇儿疾病与出生缺陷教育部重点实验室
    610041　成都，四川大学华西医院动物实验中心
    610041　成都，四川大学华西第二医院儿科；610041　成都，四川大学华西临床医学院
  • 收稿日期:2015-02-09 修回日期:2015-05-28 出版日期:2015-08-01
  • 通信作者: 华益民, 周开宇

Study on anesthesia protocols for pregnant goat during intrauterine cardiac intervention for the fetus

Xiaoqing Shi, Xiaoling Yang, Liang Zhao, Yifei Li, Chuan Wang, Yimin Hua*(), Kaiyu Zhou*()   

  1. Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu 610041, Sichuan Province, China
    Center of Animal Experiment, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
    Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China; West China School of Clinical Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2015-02-09 Revised:2015-05-28 Published:2015-08-01
  • Corresponding author: Yimin Hua, Kaiyu Zhou
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引用本文：

石晓青, 杨晓玲, 赵亮, 李一飞, 王川, 华益民, 周开宇. 胎羊宫内心脏介入手术中孕羊麻醉方案研究[J]. 中华妇幼临床医学杂志(电子版), 2015, 11(4): 448-453.

Xiaoqing Shi, Xiaoling Yang, Liang Zhao, Yifei Li, Chuan Wang, Yimin Hua, Kaiyu Zhou. Study on anesthesia protocols for pregnant goat during intrauterine cardiac intervention for the fetus[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2015, 11(4): 448-453.

目的

探讨不同4.0%水合氯醛给药方式的孕羊麻醉方案，在胎羊宫内心脏介入手术中的效果，旨在为胎儿宫内心脏介入手术麻醉方案提供依据。

方法

将40只孕龄为110～127 d的孕羊，按照随机数字表法，将其随机分为滴注组(4.0%水合氯醛持续静脉滴注)及推注组(4.0%水合氯醛负荷给药后间断静脉推注)，每组20只孕羊。观察两组实验孕羊的麻醉显效、复苏时间及麻醉状态能否满足手术要求，记录镇静剂总量，检测术前及术后2个时间点孕羊心率、平均动脉压(MAP)、血pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血糖、血乳酸、肾上腺素、去甲肾上腺素及皮质醇10项指标水平变化。比较两组孕羊麻醉效果差异，以及在不同组别及不同时间点上述10项指标的水平差异。两组孕羊体质量及孕龄比较，差异无统计学意义(P>0.05)。

结果

①两组孕羊麻醉方案比较，术前肌内注射给药、麻醉给药途径、麻醉维持时间及呼吸道控制情况等方面均相同，两组孕羊麻醉方案均能满足胎羊宫内心脏介入手术要求，但滴注组对麻醉深浅的控制稍难。两组孕羊麻醉最快显效时间及术后开始复苏时间比较，差异均无统计学意义(P>0.05)。滴注组氯胺酮剂量小于推注组[(116.3±22.5) mg vs (209.3±20.8) mg]，而4.0%水合氯醛及地西泮剂量则大于推注组[(216.7±39.7) mL vs (165.4±19.5) mL，(19.2±3.4) mg vs (10.1±2.9) mg]，孕羊术后完全复苏时间长于推注组[(273.5±26.2) min vs (191.9±33.1) min]，且差异均有统计学意义(P<0.05)。②术前两组孕羊上述10项指标水平比较，差异均无统计学意义(P>0.05)。滴注组孕羊术后血乳酸、肾上腺素、去甲肾上腺素及皮质醇含量较术前增高[分别为(6.0±0.8) mmol/L vs (3.7±0.6) mmol/L，(626.3±99.4) ng/L vs (167.3±35.4) ng/L，(6 631.9±753.2) ng/L vs (1 938.5±393.3) ng/L，(509.0±133.6) ng/L vs (219.9±33.3) ng/L]；推注组孕羊术后该4项指标含量较术前增高[分别为(5.0±0.6) mmol/L vs (3.2±0.8) mmol/L，(336.5±58.6) ng/L vs (189.6±32.4) ng/L，(4 063.5±834.7) ng/L vs (2 133.8±323.7) ng/L，(305.9±64.7) ng/L vs (187.3±31.5) ng/L]；术后该4项指标在滴注组均较推注组高[分别为(6.0±0.8) mmol/L vs (5.0±0.6) mmol/L，(626.3±99.4) ng/L vs (336.5±58.6) ng/L，(6 631.9±753.2) ng/L vs (4 063.5±834.7) ng/L，(509.0±133.6) ng/L vs (305.9±64.7) ng/L]，两组上述指标比较，差异均有统计学意义(P<0.05)。而孕羊心率、MAP、血pH值及PaO2在不同组别或同组内的不同时间点(术前或术后)比较，差异均无统计学意义(P>0.05)。

结论

胎羊宫内心脏介入手术中，4.0%水合氯醛间断推注给药联合使用氯胺酮及地西泮的孕羊麻醉方案，因4.0%水合氯醛及地西泮剂量较小，具有安全性更高、更易于掌握的特点。

关键词: 水合氯醛, 超声检查，介入的, 心脏外科手术, 麻醉, 山羊
Objective

To explore the effects of different 4.0% chloral hydrate administered modes of anesthesia for pregnant goat during fetal goat intrauterine cardiac intervention program to provide basis of anesthesia for fetal intrauterine cardiac intervention program.

Methods

A total of 40 pregnant goats who were being pregnant for 110-127 d were divided into infusion group (4.0% chloral hydrate continuous intravenous infusion) and injection group (4.0% chloral hydrate intermittent intravenous injection after load) in accordance with random digits table, and each group contained 20 pregnant goats.To observe anesthesia effect and recovery time, and whether anesthesia state could meet the operation requirements or not of two groups of pregnant goats, recorded total sedative dose.Detected 10 kinds of indicators including heart rate, mean arterial blood pressure(MAP), blood pH value, arterial partial pressure of oxygen(PaO2), arterial partial pressure of carbon dioxide (PaCO2), blood glucose, blood lactic acid, epinephrine, norepinephrine and cortisol of pregnant goats at 2 time points of preoperative and postoperative.Compared difference of anesthesia effect between two groups and differences of these 10 kinds of indicators between different groups and time points.There were no significant differences between two groups in pregnant goat body mass and gestational age(P>0.05).

Results

①Comparison of anesthesia between two groups, preoperative intramuscular injection medicine, route of administration, duration of anesthesia and airway control were all the same, both two kinds of anesthesia could meet the requirements of intrauterine intervention for fetal goat, but there were slightly difficult for infusion group to control anesthesia depth.There were no significant differences between two groups in anesthesia effective time and postoperative starting recovery time (P>0.05). Ketamine doses in infusion group was less than injection group [(116.3±22.5) mg vs (209.3±20.8) mg], while 4.0% chloral hydrate and diazepam dose were more than injection group [(216.7±39.7) mL vs (165.4±19.5) mL, (19.2±3.4) mg vs (10.1±2.9) mg], the postoperative full recovery time was longer than injection group [(273.5±26.2) min vs (191.9±33.1) min], and there were significant differences(P<0.05). ②There were no significant differences between two groups in these 10 kinds of indicator before intervention(P>0.05). The level of blood lactate, epinephrine, norepinephrine and cortisol of pregnant goats after intervention were all higher than those of before intervention in infusion group [(6.0±0.8) mmol/L vs (3.7±0.6) mmol/L, (626.3±99.4) ng/L vs (167.3±35.4) ng/L, (6 631.9±753.2) ng/L vs (1 938.5±393.3) ng/L, (509.0±133.6) ng/L vs (219.9±33.3) ng/L]; and the same results in injection group[(5.0±0.6) mmol/L vs (3.2±0.8) mmol/L, (336.5±58.6) ng/L vs (189.6±32.4) ng/L, (4 063.5±834.7) ng/L vs (2 133.8±323.7) ng/L, (305.9±64.7) ng/L vs (187.3±31.5) ng/L]; the levels of these 4 kinds of indicator in infusion group after intervention were higher than those in injection group after intervention [(6.0±0.8) mmol/L vs (5.0±0.6) mmol/L, (626.3±99.4) ng/L vs (336.5±58.6) ng/L, (6 631.9±753.2) ng/L vs (4 063.5±834.7) ng/L, (509.0±133.6) ng/L vs (305.9±64.7) ng/L], and there were significant differences above all(P<0.05). There were no significant differences between any two groups or in the same group in any time point in pregnancy goat heart rate, MAP, blood pH value and PaO2(P>0.05).

Conclusions

The anesthesia program of 4.0% chloral hydrate intermittent injection combine with ketamine and diazepam in pregnant goat during fetal goat intrauterine cardiac intervention program was more secure and easier to operate because of the reduction dose of 4.0% chloral hydrate and diazepam.

Key words: Chloral hydrate, Ultrasonography, interventional, Cardiac surgical procedures, Anesthesia, Goats
表1 两组孕羊麻醉方案及效果比较(±s)
组别 羊数 孕羊体质量(kg) 孕龄(d) 术前肌内注射阿托品剂量(mg) 麻醉药物及总量 麻醉给药途径
4.0%水合氯醛(mL) 氯胺酮(mg) 地西泮(mg)
滴注组 20 41.4±6.7 111.3±8.6 0.5 216.7±39.7 116.3±22.5 19.2±3.4 静脉、肌内注射
推注组 20 38.2±7.3 113.8±9.5 0.5 165.4±19.5 209.3±20.8 10.1±2.9 静脉、肌内注射
t值   0.90 0.60 － 3.30 7.80 5.75 －
P值   >0.05 >0.05 － <0.05 <0.05 <0.05 －
组别 羊数 麻醉最快显效时间(min) 麻醉维持时间 控制麻醉深浅的难易程度 麻醉能否满足胎羊宫内介入手术 呼吸道控制情况(气管插管) 术后开始复苏时间(min) 术后完全复苏时间(min)
滴注组 20 3.9±1.7 持续 稍难 能 好 11.9±3.8 273.5±26.2
推注组 20 4.1±1.9 持续 易 能 好 13.1±2.6 191.9±33.1
t值   0.30 － － － － 0.70 5.50
P值   >0.05 － － － － >0.05 <0.05
表2 滴注组孕羊术前及术后10项监测指标比较(±s)
时间点 羊数 心率(次/min) MAP(mmHg) 血pH值 PaO2(mmHg) PaCO2(mmHg) 血糖(mmol/L) 血乳酸(mmol/L) 肾上腺素(ng/L) 去甲肾上腺素(ng/L) 皮质醇(ng/L)
术前 20 129±18 75.2±6.8 7.31±0.05 89.6±8.4 34.2±5.6 4.2±1.0 3.7±0.6 167.3±35.4 1 938.5±393.3 219.9± 33.3
术后 20 137±25 69.5±9.7 7.29±0.04 78.9±9.1 33.8±4.9 7.5±1.8 6.0±0.8 626.3±99.4 6 631.9±753.2 509.0±133.6
t值   1.16 2.00 1.39 1.60 3.86 7.05 3.70 4.50 24.70 54.90
P值   >0.05 >0.05 >0.05 >0.05 <0.05 <0.05 <0.05 <0.05 <0.05 <0.05
表3 推注组孕羊术前及术后10项监测指标比较(±s)
时间点 羊数 心率(次/min) MAP(mmHg) 血pH值 PaO2(mmHg) PaCO2(mmHg) 血糖(mmol/L) 血乳酸(mmol/L) 肾上腺素(ng/L) 去甲肾上腺素(ng/L) 皮质醇(ng/L)
术前 20 131±21 70.3±5.9 7.28±0.06 85.3±12.8 36.4±6.3 5.1±1.1 3.2±0.8 189.6±32.4 2 133.8±323.7 187.3±31.5
术后 20 133±21 73.5±8.8 7.27±0.05 79.4±11.5 37.1±4.9 6.7±1.8 5.0±0.6 336.5±58.6 4 063.5±834.7 305.9±64.7
t值   0.30 1.30 0.57 1.50 0.39 3.40 7.50 9.80 9.60 7.40
P值   >0.05 >0.05 >0.05 >0.05 >0.05 <0.05 <0.05 <0.05 <0.05 <0.05
表4 两组孕羊术后10项监测指标比较(±s)
组别 羊数 心率(次/min) MAP(mmHg) 血pH值 PaO2(mmHg) PaCO2(mmHg) 血糖(mmol/L) 血乳酸(mmol/L) 肾上腺素(ng/L) 去甲肾上腺素(ng/L) 皮质醇(ng/L)
滴注组 20 137±25 69.5±9.7 7.29±0.04 78.9± 9.1 33.8±4.9 7.5±1.8 6.0±0.8 626.3±99.4 6 631.9±753.2 509.0±133.6
推注组 20 133±21 73.5±8.8 7.27±0.05 79.4±11.5 37.1±4.9 6.7±1.8 5.0±0.6 336.5±58.6 4 063.5±834.7 305.9± 64.7
t值   0.55 1.30 1.40 0.15 2.12 1.38 4.49 11.21 10.21 6.11
P值   >0.05 >0.05 >0.05 >0.05 <0.05 >0.05 <0.05 <0.05 <0.05 <0.05
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