舒芬太尼在剖宫产患者的胎盘转移及对新生儿的影响
发布时间：2018-09-05 11:37
【摘要】：目的通过观测产妇和新生儿的各项指标及测定胎儿娩出时母体静脉血(MV)、脐动脉血(UA)和脐静脉血(UV)中舒芬太尼的血药浓度,初步探讨舒芬太尼静脉注射在剖宫产患者的胎盘转移情况及对新生儿的影响。方法选择ASAI~II级择期硬膜外阻滞下行剖宫产术的患者40例,随机分为两组,每组20例。舒芬太尼组(S组)于胎儿娩出前十分钟静脉注射舒芬太尼0.15ug/kg,而对照组(C组)给予相同体积的生理盐水2ml。于胎儿娩出时分别抽取舒芬太尼组(S组)脐动脉(UA)、脐静脉(UV)及母体静脉(MV)血各3ml,加入60μl 50%柠檬酸钠溶液离心取上清液,保存于液氮罐中待检,另取1ml脐动脉(UA)做血气分析。对照组(C组)仅抽取脐动脉(UA)血1ml做血气分析。术中对产妇无创血压(NIBP)、心电图(ECG)、心率(HR)及血氧饱和度(Sp O2)进行分别监测。记录5个时间点产妇的呼吸频率(RR)、平均动脉压(MBP)、心率(HR)、视觉模拟疼痛评分(Visual Analogue Score,VAS)及镇静评分(Ramsay);记录产妇术中不良反应和子宫切开到胎儿娩出时间(TU-D);记录新生儿1、5、10min Apgar评分以及2h和24h神经行为评分(Neonatal Behavioral Neurological Assessment,NBNA)。使用液-液萃取毛细管气相色谱—质谱联用法检测试验组的脐动脉血(UA)、脐静脉血(UV)和母体静脉(MV)血中舒芬太尼的浓度,内标选择枸橼酸芬太尼注射液。1ml上清液融化后迅速加入10ul芬太尼(100ng/ml)和2ml乙腈,高速旋涡混合10min。再分别加入乙酸乙酯和石油醚各2.5ml,高速旋涡混合20min,用离心机2200 r/min离心10min,用10ml的尖嘴硅硼酸玻璃试管盛取上层有机溶液,30℃环境下用流速为2 L/min的氮气流缓慢吹干玻璃试管内的溶液,用一次性滴管将5ml石油醚沿试管壁缓慢滴下以冲洗管壁上附着的残留固体,再次用氮气吹干。将最终的残留物用100ul甲醇旋涡溶解3min后进样检测。色谱条件:色谱柱:DB-5MS,30m×250um×0.25um。升温程序:初始温度设定为130℃,温度达到后继续维持2.5min,然后以50℃/min上升到210℃,再以6℃/min上升到290℃,载气为高纯度的氮气,恒流流速设定为1ml/min,不分流进样。进样口温度设定为290℃,进样量1.0ul;质谱参数:离子源温度设定为250℃,电离方式EM,EM电压2118V,四级杆温度150℃,柱箱温度130℃。使用选择性离子监测模式(SIM)对舒芬太尼浓度进行监测从而增强检测的灵敏度。选择离子质量数m/z为289和140的离子对舒芬太尼进行检测,m/z为245、146、189、105的离子对芬太尼进行检测。结果1胎儿娩出时母体静脉(MV)中舒芬太尼的平均血药浓度为(1.68±0.31)ng/ml,脐动脉(UA)与脐静脉(UV)血中血药浓度低于该检测方法的检测低线0.1 ng/ml。CUV/CMV与CUA/CMV低于0.06±0.01。2与C组和入室平静后的基础值比较,S组在手术开始切皮时和胎儿娩出子宫时产妇Ramsay镇静评分均显著升高(P0.05),视觉模拟疼痛评分减低(P0.05),差异有统计学意义;两组新生儿Apgar评分、NBNA评分、不良反应评分比较差异无统计学意义(P0.05)。结论1硬膜外阻滞下行剖宫产术时,静脉给予产妇舒芬太尼0.15ug/kg10min后舒芬太尼胎盘透过率不超过6%。2硬膜外阻滞下行剖宫产术时,静脉给予产妇舒芬太尼0.15ug/kg能增强麻醉镇静镇痛效果,且对出生24小时内的新生儿无明显不良影响。
[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.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
本文编号：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.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
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