背景:在怀孕期间,生理变化会增加母亲和胎儿的氧化应激(OS)。剖宫产术(CSs)使用麻醉可能会加剧这种压力,因为它对缺血再灌注效应的影响。我们的研究旨在探讨靶控输注异丙酚对CSs期间OS的影响。并将这些效果与脊髓和硫喷妥钠-七氟醚麻醉的效果进行比较。
方法:该研究包括90例接受选择性CS的产妇,分为三组:S组(脊髓)(n=30),P组(异丙酚)(n=30),和TS组(硫喷妥钠-七氟醚)(n=30)。在三个时间点从母亲那里采集静脉血样,之前,during,手术后,分娩后从脐静脉采集一个样本。血液样品用硫代巴比妥酸反应性物质(TBARS)测定和血气分析进行分析。在适当的情况下,通过单向方差分析(ANOVA)和Wilcoxon检验获得组间的统计比较。
结果:麻醉诱导后所有组的TBARS水平均低于术前。P组,TBARS水平在诱导后的前五分钟开始降低(1.90±0.47;P<0.001),并且与S组(2.22±0.21)和TS组(2.40±0.20)相比具有显著更低的值。手术后两小时,P组TBARS值最低(1.76±0.15,P<0.001),与S组(2.18±0.24)和TS组(2.41±0.21)比较。P组脐静脉血TBARS值(1.56±0.16,P<0.001)明显低于S组(2.18±0.17)和TS组(2.09±0.09)。脐静脉血气值(pH,PCO2,HCO3,乳酸盐,和碱基过量(BE))在组间没有差异,除PO2外,S组(20.5±5.0;P<0.001)明显低于P组(36.5±19.2)和TS组(33.5±10.1)。
结论:靶控输注丙泊酚麻醉可能有利于氧化状态受损的产妇,尤其是在需要全身麻醉时接受紧急CSs的患者。
BACKGROUND: During pregnancy, physiological changes can increase oxidative stress (OS) in both mothers and fetuses. The use of anesthesia for cesarean sections (CSs) could exacerbate this stress due to its impact on the ischemia-reperfusion effect. Our study aimed to explore the effects of target-controlled infusion of propofol on OS during CSs, and to compare these effects with those of spinal and thiopental-sevoflurane anesthesia.
METHODS: The study included ninety parturients undergoing elective CS, allocated into three groups: Group S (spinal) (n = 30), Group P (propofol) (n = 30), and Group TS (thiopental-sevoflurane) (n = 30). Venous blood samples were taken from mothers at three time points, before, during, and after surgery, and one sample was taken from the umbilical vein after delivery. Blood samples were analyzed with the thiobarbituric acid reactive substances (TBARS) assay and blood gas analysis. A statistical comparison between groups was obtained by one-way analysis of variance (ANOVA) and the Wilcoxon test where appropriate.
RESULTS: Levels of TBARS after the induction of anesthesia were lower in all groups compared to values preoperatively. In Group P, TBARS levels started to decrease in the first five minutes after the induction (1.90 ± 0.47; P < 0.001) and had significantly lower values compared to Group S (2.22 ± 0.21) and Group TS (2.40 ± 0.20). Two hours after surgery, TBARS values were the lowest in Group P (1.76 ± 0.15, P<0.001), compared to Group S (2.18 ± 0.24) and Group TS (2.41 ± 0.21). TBARS value in umbilical venous blood was significantly lower in Group P (1.56 ± 0.16, P < 0.001) compared to Group S (2.18 ± 0.17) and Group TS (2.09 ± 0.09). Umbilical cord venous blood gas values (pH, PCO2, HCO3, lactates, and base excess (BE)) were not different between the groups, except for PO2, which was significantly lower in Group S (20.5 ± 5.0; P < 0.001) compared to Group P (36.5 ± 19.2) and Group TS (33.5 ± 10.1).
CONCLUSIONS: Target-controlled infusion of propofol anesthesia could be advantageous for parturients with compromised oxidative status, especially those undergoing emergency CSs when general anesthesia is required.