舒芬太尼在剖宮產(chǎn)患者的胎盤轉(zhuǎn)移及對新生兒的影響
發(fā)布時間：2018-09-05 11:37
【摘要】：目的通過觀測產(chǎn)婦和新生兒的各項指標及測定胎兒娩出時母體靜脈血(MV)、臍動脈血(UA)和臍靜脈血(UV)中舒芬太尼的血藥濃度,初步探討舒芬太尼靜脈注射在剖宮產(chǎn)患者的胎盤轉(zhuǎn)移情況及對新生兒的影響。方法選擇ASAI~II級擇期硬膜外阻滯下行剖宮產(chǎn)術(shù)的患者40例,隨機分為兩組,每組20例。舒芬太尼組(S組)于胎兒娩出前十分鐘靜脈注射舒芬太尼0.15ug/kg,而對照組(C組)給予相同體積的生理鹽水2ml。于胎兒娩出時分別抽取舒芬太尼組(S組)臍動脈(UA)、臍靜脈(UV)及母體靜脈(MV)血各3ml,加入60μl 50%檸檬酸鈉溶液離心取上清液,保存于液氮罐中待檢,另取1ml臍動脈(UA)做血氣分析。對照組(C組)僅抽取臍動脈(UA)血1ml做血氣分析。術(shù)中對產(chǎn)婦無創(chuàng)血壓(NIBP)、心電圖(ECG)、心率(HR)及血氧飽和度(Sp O2)進行分別監(jiān)測。記錄5個時間點產(chǎn)婦的呼吸頻率(RR)、平均動脈壓(MBP)、心率(HR)、視覺模擬疼痛評分(Visual Analogue Score,VAS)及鎮(zhèn)靜評分(Ramsay);記錄產(chǎn)婦術(shù)中不良反應(yīng)和子宮切開到胎兒娩出時間(TU-D);記錄新生兒1、5、10min Apgar評分以及2h和24h神經(jīng)行為評分(Neonatal Behavioral Neurological Assessment,NBNA)。使用液-液萃取毛細管氣相色譜—質(zhì)譜聯(lián)用法檢測試驗組的臍動脈血(UA)、臍靜脈血(UV)和母體靜脈(MV)血中舒芬太尼的濃度,內(nèi)標選擇枸櫞酸芬太尼注射液。1ml上清液融化后迅速加入10ul芬太尼(100ng/ml)和2ml乙腈,高速旋渦混合10min。再分別加入乙酸乙酯和石油醚各2.5ml,高速旋渦混合20min,用離心機2200 r/min離心10min,用10ml的尖嘴硅硼酸玻璃試管盛取上層有機溶液,30℃環(huán)境下用流速為2 L/min的氮氣流緩慢吹干玻璃試管內(nèi)的溶液,用一次性滴管將5ml石油醚沿試管壁緩慢滴下以沖洗管壁上附著的殘留固體,再次用氮氣吹干。將最終的殘留物用100ul甲醇旋渦溶解3min后進樣檢測。色譜條件:色譜柱:DB-5MS,30m×250um×0.25um。升溫程序:初始溫度設(shè)定為130℃,溫度達到后繼續(xù)維持2.5min,然后以50℃/min上升到210℃,再以6℃/min上升到290℃,載氣為高純度的氮氣,恒流流速設(shè)定為1ml/min,不分流進樣。進樣口溫度設(shè)定為290℃,進樣量1.0ul;質(zhì)譜參數(shù):離子源溫度設(shè)定為250℃,電離方式EM,EM電壓2118V,四級桿溫度150℃,柱箱溫度130℃。使用選擇性離子監(jiān)測模式(SIM)對舒芬太尼濃度進行監(jiān)測從而增強檢測的靈敏度。選擇離子質(zhì)量數(shù)m/z為289和140的離子對舒芬太尼進行檢測,m/z為245、146、189、105的離子對芬太尼進行檢測。結(jié)果1胎兒娩出時母體靜脈(MV)中舒芬太尼的平均血藥濃度為(1.68±0.31)ng/ml,臍動脈(UA)與臍靜脈(UV)血中血藥濃度低于該檢測方法的檢測低線0.1 ng/ml。CUV/CMV與CUA/CMV低于0.06±0.01。2與C組和入室平靜后的基礎(chǔ)值比較,S組在手術(shù)開始切皮時和胎兒娩出子宮時產(chǎn)婦Ramsay鎮(zhèn)靜評分均顯著升高(P0.05),視覺模擬疼痛評分減低(P0.05),差異有統(tǒng)計學意義;兩組新生兒Apgar評分、NBNA評分、不良反應(yīng)評分比較差異無統(tǒng)計學意義(P0.05)。結(jié)論1硬膜外阻滯下行剖宮產(chǎn)術(shù)時,靜脈給予產(chǎn)婦舒芬太尼0.15ug/kg10min后舒芬太尼胎盤透過率不超過6%。2硬膜外阻滯下行剖宮產(chǎn)術(shù)時,靜脈給予產(chǎn)婦舒芬太尼0.15ug/kg能增強麻醉鎮(zhèn)靜鎮(zhèn)痛效果,且對出生24小時內(nèi)的新生兒無明顯不良影響。
[Abstract]:Objective To investigate the placental metastasis of sufentanil by intravenous injection in cesarean section and its effect on neonates by observing the indexes of maternal and neonatal and determining the concentration of sufentanil in maternal venous blood (MV), umbilical artery blood (UA) and umbilical vein blood (UV) during fetal delivery. Sufentanil group (S group) was intravenously injected with sufentanil 0.15ug/kg 10 minutes before delivery, while the control group (C group) was given the same volume of saline 2 ml. Sufentanil group (S group) was taken out of umbilical artery (UA), umbilical vein (UV) and maternal sedation respectively. Pulse (MV) blood was 3 ml each, 60 ml 50% sodium citrate solution was added to centrifuge the supernatant, which was stored in liquid nitrogen tank for examination, and 1 ml umbilical artery (UA) was taken for blood gas analysis. The control group (group C) only took 1 ml umbilical artery (UA) blood for blood gas analysis. Respiratory frequency (RR), mean arterial pressure (MBP), heart rate (HR), Visual Analogue Score (VAS) and sedation score (Ramsay) were recorded at 5 time points, intraoperative adverse reactions and time from hysterectomy to fetal delivery (TU-D) were recorded, Apgar score at 1,5,10 minutes and Neona neurobehavioral score at 2 and 24 hours were recorded. The concentration of sufentanil in umbilical artery blood (UA), umbilical vein blood (UV) and maternal vein blood (MV) was determined by liquid-liquid extraction capillary gas chromatography-mass spectrometry. The internal standard was fentanyl citrate injection. 2 ml acetonitrile and 2 ml acetonitrile were mixed for 10 min by high speed vortex. Ethyl acetate and petroleum ether were added respectively for 2.5 ml, high speed vortex was mixed for 20 min, centrifuged for 10 min with a centrifuge of 2200 r/min, superficial organic solution was taken in a 10 ml tip silica-boric acid glass test tube, and the solution was slowly dried in a glass test tube with a nitrogen flow rate of 2 L/min at 30 C. The dropper drips 5 ml petroleum ether slowly down the wall of the test tube to wash out the remaining solids attached to the wall of the test tube and dries them again with nitrogen. The final residue is dissolved in a 100 UL methanol vortex for 3 minutes and then sampled for detection. The temperature of the inlet was set at 290 C, the sample volume was 1.0ul, and the mass spectrometry parameters were set at 250 C, the ionization mode EM, the EM voltage 2118V, the four-stage rod temperature 150 C and the column temperature 130 C. The concentration of sufentanil was monitored by selective ion monitoring (SIM) to enhance the sensitivity of the assay. Sufentanil was detected by ion pairs of 289 and 140 with m/z of 245,146,189 and 105. Results 1 The average blood concentration of sufentanil in maternal vein (MV) during fetal delivery. The serum concentration of UA and UV was lower than the detection low line of 0.1 ng/ml. CUV/CMV and CA/CMV were lower than the baseline values of 0.06+0.01.2 and 0.06+0.01.2 in group C. The Ramsay sedation score of parturients in group S increased significantly at the beginning of skin incision and at the time of fetal delivery (P 0.05). Visual analogue pain score decreased (P 0.05), the difference was statistically significant; Apgar score, NBNA score, adverse reaction score between the two groups was not statistically significant (P 0.05). Conclusion 1 In epidural block cesarean section, intravenous sufentanil 0.15ug/kg for 10 minutes after cesarean section, sufentanil placental permeability was not more than 6%. Intravenous administration of sufentanil 0.15ug/kg during cesarean section under anesthesia can enhance the effect of anesthesia, sedation and analgesia, and has no significant adverse effect on newborns within 24 hours of birth.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614
本文編號：2224151
[Abstract]:Objective To investigate the placental metastasis of sufentanil by intravenous injection in cesarean section and its effect on neonates by observing the indexes of maternal and neonatal and determining the concentration of sufentanil in maternal venous blood (MV), umbilical artery blood (UA) and umbilical vein blood (UV) during fetal delivery. Sufentanil group (S group) was intravenously injected with sufentanil 0.15ug/kg 10 minutes before delivery, while the control group (C group) was given the same volume of saline 2 ml. Sufentanil group (S group) was taken out of umbilical artery (UA), umbilical vein (UV) and maternal sedation respectively. Pulse (MV) blood was 3 ml each, 60 ml 50% sodium citrate solution was added to centrifuge the supernatant, which was stored in liquid nitrogen tank for examination, and 1 ml umbilical artery (UA) was taken for blood gas analysis. The control group (group C) only took 1 ml umbilical artery (UA) blood for blood gas analysis. Respiratory frequency (RR), mean arterial pressure (MBP), heart rate (HR), Visual Analogue Score (VAS) and sedation score (Ramsay) were recorded at 5 time points, intraoperative adverse reactions and time from hysterectomy to fetal delivery (TU-D) were recorded, Apgar score at 1,5,10 minutes and Neona neurobehavioral score at 2 and 24 hours were recorded. The concentration of sufentanil in umbilical artery blood (UA), umbilical vein blood (UV) and maternal vein blood (MV) was determined by liquid-liquid extraction capillary gas chromatography-mass spectrometry. The internal standard was fentanyl citrate injection. 2 ml acetonitrile and 2 ml acetonitrile were mixed for 10 min by high speed vortex. Ethyl acetate and petroleum ether were added respectively for 2.5 ml, high speed vortex was mixed for 20 min, centrifuged for 10 min with a centrifuge of 2200 r/min, superficial organic solution was taken in a 10 ml tip silica-boric acid glass test tube, and the solution was slowly dried in a glass test tube with a nitrogen flow rate of 2 L/min at 30 C. The dropper drips 5 ml petroleum ether slowly down the wall of the test tube to wash out the remaining solids attached to the wall of the test tube and dries them again with nitrogen. The final residue is dissolved in a 100 UL methanol vortex for 3 minutes and then sampled for detection. The temperature of the inlet was set at 290 C, the sample volume was 1.0ul, and the mass spectrometry parameters were set at 250 C, the ionization mode EM, the EM voltage 2118V, the four-stage rod temperature 150 C and the column temperature 130 C. The concentration of sufentanil was monitored by selective ion monitoring (SIM) to enhance the sensitivity of the assay. Sufentanil was detected by ion pairs of 289 and 140 with m/z of 245,146,189 and 105. Results 1 The average blood concentration of sufentanil in maternal vein (MV) during fetal delivery. The serum concentration of UA and UV was lower than the detection low line of 0.1 ng/ml. CUV/CMV and CA/CMV were lower than the baseline values of 0.06+0.01.2 and 0.06+0.01.2 in group C. The Ramsay sedation score of parturients in group S increased significantly at the beginning of skin incision and at the time of fetal delivery (P 0.05). Visual analogue pain score decreased (P 0.05), the difference was statistically significant; Apgar score, NBNA score, adverse reaction score between the two groups was not statistically significant (P 0.05). Conclusion 1 In epidural block cesarean section, intravenous sufentanil 0.15ug/kg for 10 minutes after cesarean section, sufentanil placental permeability was not more than 6%. Intravenous administration of sufentanil 0.15ug/kg during cesarean section under anesthesia can enhance the effect of anesthesia, sedation and analgesia, and has no significant adverse effect on newborns within 24 hours of birth.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614
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