麻醉学学科外文期刊摘要翻译

麻海涛涛

本人小硕一枚 初来乍到 发帖翻文 为的是自身学习和与他人交流 译文有诸多不妥之处 敬请各位前辈指导斧正~~~
[第一篇]胎儿手术麻醉技术：在绵羊模型上施行母体麻醉对术中胎儿疗效的影响 Anesthesiology.118(4):796-808,April 2013.

Anesthetic Techniques for Fetal Surgery：Effects of Maternal Anesthesia on Intraoperative Fetal Outcomes in a Sheep Model



Pornswan Ngamprasertwong, M.D., M.S.,* Erik C. Michelfelder, M.D.,† Shahriar Arbabi, M.D.,‡ Yun Suk Choi, M.D.,§ Christopher Statile, M.D.,‖ Lili Ding, Ph.D.,# Anne Boat, M.D.,**Pirooz Eghtesady, M.D., Ph.D.,†† Katherine Holland, M.D., Ph.D.,‡‡ Senthilkumar Sadhasivam, M.D., M.P.H.**

ABSTRACT

Background: Use of high-dose inhalational anesthesia dur -ing open fetal surgery may induce maternal–fetal hemo -dynamic instability and fetal myocardial depression. The authors’ preliminary human retrospective study demon -strated less fetal bradycardia and left ventricular systolic dysfunction with lower dose desflurane supplemented with propofol and remifentanil IV anesthesia (SIVA). In this animal study, the authors compare maternal–fetal effects of high-dose desflurane anesthesia (HD-DES) and SIVA.

Methods: Of 26 instrumented midgestational ewes, data from 11 animals exposed to both SIVA and HD-DES in ran -dom sequences and six animals exposed to HD-DES while maternal normotension was maintained were analyzed.Maternal electroencephalography was used to guide compa-rable depths of anesthesia in both techniques. Hemodynamic parameters, blood gas, and fetal cardiac function from echo-cardiography were recorded.

Results: Compared with SIVA, HD-DES resulted in significant maternal hypotension (mean arterial pressure difference, 19.53 mmHg; 95% CI, 17.6–21.4; P < 0.0001),fetal acidosis (pH 7.11 vs.  7.24 at 150  min, P < 0.001), and decreased uterine blood flow. In the HD-DES group with maternal normotension, uterine blood flow still declined and fetal acidosis persisted, with no statistically significant difference from the group exposed to HD-DES that had maternal hypotension.There was no statistically significant difference in fetal cardiac function.

Conclusion:  In sheep, SIVA affects maternal hemodynamics less and provides better fetal acid/base status than high-dose desflurane.Fetal echocardiography did not reflect myocardial dysfunction in this model.


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胎儿手术麻醉技术：在绵羊模型上施行母体麻醉对术中胎儿疗效的影响


【摘要】

背景 在开放性胎儿手术过程中使用大剂量的吸入麻醉药有可能导致母体—胎儿的血流动力学波动并对胎儿产生心肌抑制作用。作者们最初对人类进行的回顾性研究表明，在使用较低剂量的地氟烷复合丙泊酚和瑞芬太尼静脉麻醉（SIVA）时，胎儿心动过缓和做事收缩功能障碍的发生率较低。

方法 在26只经处理的妊娠中期的绵羊中，按随机顺序收集11只经SIVA麻醉和经大剂量地氟烷麻醉的绵羊的数据，并收集6只经大剂量地氟烷麻醉并且母体血压正常的绵羊的数据，并对这些数据加以分析。监测母体脑电图用于指导比较两种麻醉方法所达到的麻醉深度。记录血流动力学参数和血气分析值并且利用超声心动图记录胎儿心功能。

结果 与SIVA相比，大剂量地氟烷导致显著的母体低血压（平均动脉压差异，19.53mmHg;95%心指数，17.6—21.4；P<0.0001），胎儿酸中毒（pH7.11vs.pH7.24 at 150分钟，P<0.001）以及子宫血流减少。在大剂量地氟烷组中的母体血压正常的实验动物，依然会出现子宫血流减少和胎儿酸中毒，并且与使用大剂量地氟烷麻醉而出现母体低血压的实验组相比，在统计学上无显著的差异。在胎儿心功能方面无显著的统计学差异。

结论 对于绵羊动物模型来说，与使用大剂量地氟烷麻醉相比较，SIVA对母体的血流动力学影响较小，并且能够提供更好的酸碱平衡状态。在这种模型上，胎儿超声心动图未显示出心肌功能障碍。