不同麻醉方式在妊娠高血压疾病剖宫产术中的应用比较

目的:比较单纯硬膜外麻醉、腰麻-硬膜外联合麻醉、静脉麻醉在妊娠高血压疾病剖宫产中的实施效果,探讨适合的麻醉方法.方法:回顾性分析2006年1月-2010年10月420例我院妊娠高血压疾病剖宫产的产妇的临床资料.结果:420例剖宫产的产妇中采用单纯硬膜外麻醉60例,腰麻-硬膜外联合麻醉340例,静脉麻醉20例;3组患者均顺利完成手术.单纯硬膜外麻醉在起效慢、麻醉效果不满意;腰麻-硬膜外联合麻醉组低血压发生率较高;静脉麻醉组新生儿Apgar评分与其它两组相比偏低,但无显著差异.结论:腰麻-硬膜外联合在妊高征剖宫产手术中的优势明显,是一种较好的麻醉方法,对于各种原因未能成功实施椎管内麻醉及重症产妇,可选择静脉麻醉.     

妊娠晚期合并心衰患者剖宫产术的麻醉处理

晚期妊娠合并心衰，对孕妇的生命及胎儿的存活威胁极大，要在积极控制心衰的同时行剖宫产术。虽然现在手术技巧、麻醉及监测手段已有显著提高，但术中风险仍然很大。我院自1990年来共进行此类手术7例，母婴均康复出院，现报道如下。     

妊娠合并HELLP综合征剖宫产术的麻醉处理

HELLP（H-溶血、EL-肝酶升高、LP-血小板减少）综合征是妊娠高血压综合征（妊高征）的严重并发征,该综合征发病率低,但起病急骤、病情危重,严重威肋母婴生命,手术麻醉风险较大.现将我院2003年3月～2005年3月4例HELLP综合征剖宫产术的麻醉报道如下.     

妊娠合并严重二尖瓣狭窄患者剖宫产术的麻醉处理

我院近5年接诊3例妊娠34+周合并严重二尖瓣狭窄行剖宫产术患者,现将其诊治情况总结如下: 资料与方法 3例患者,年龄24～27岁,妊娠34+～36+周,宫内活胎。心功能Ⅳ级。HR110～130次/min、RR28～34次/min、BP98～120/70～90mmHg。心脏彩超示:二尖瓣重度狭窄(瓣口面积分别为0.82、0.90、0.96cm2)伴有肺动脉高压(中～重度),射     

妊娠合并重症肝炎的产后护理

目的 探讨妊娠合并重症肝炎患者产后有效的护理措施.方法 回顾性分析16例妊娠合并重症肝炎患者的临床资料和护理措施.结果 13例临床治愈出院,1例因经济原因病情好转后出院,2例(12.5%)因多脏器功能衰竭死亡.结论 恰当的护理是促进妊娠合并重症肝炎患者产后病情稳定及康复的有效措施.     

妊娠合并多发性大动脉炎行剖宫产术的麻醉一例

患者 ,女 ,2 3岁 ,体重 72kg ,因足月妊娠、头盆不称 ,全身大动脉炎入院行剖宫产术。患者于孕期 3、7月时分别常规查体 ,双上肢均未测及血压及脉搏 ,但无异常不适 ,未行任何治疗措施 ,否认家族及个人有重大疾病及遗传病史。术前检查 :T 36 5℃ ,P双侧桡动脉测不到 ,HR 89次 /分 ,RR 2 2次 /分 ,BP双侧肱动脉测不到。查体 :双下肢足背动脉搏动尚好 ,心肺功能正常 ,颈部可闻及血管杂音 ;二维超声所见 :双颈总动脉、锁骨下动脉、腋动脉及头臂干内膜均明显增厚 ,左颈总动脉面积狭窄率 5 0 % ,右颈总动脉面积狭窄率 6 0 % ,流速分别为 2 0 …     

硬膜外麻醉与全麻对剖宫产术新生儿的影响比较

目的观察比较硬膜外麻醉与全身麻醉对剖宫产术新生儿的影响。方法选择足月妊娠行剖宫产术的中国孕妇100例和赞比亚孕妇100例。ASA(美国麻醉医师协会分级法)Ⅰ～Ⅱ级,无妊高征,无产前子痫,无胎儿宫内窘迫,胎儿发育良好。中国孕妇,在硬膜外麻醉下行剖宫产手术(EA组);赞比亚孕妇,在硫苯妥钠、氟烷加肌松剂全身麻醉下行剖宫产手术(GA组)。两组产妇术中均监测ECG、HR、BP和SpO2;观察比较两组自麻醉开始至胎儿娩出时间,新生儿体重,新生儿Apgar评分。结果两组产妇术中ECG均为窦性心律;EA组术中HR显著慢于GA组,P<0.05;EA组BP显著低于GA组P<0.05,两组SpO2均可维持在96%～100%,两组相比差异无统计学意义,P>0.05;两组自麻醉开始至胎儿娩出时间GA组短于EA组;新生儿体重两组间比较差异无统计学意义,P>0.05;新生儿Apgar评分,EA组显著高于GA组,P<0.05。结论硬膜外麻醉对剖宫产术新生儿的影响显著小于全身麻醉。     

妊娠晚期心衰产妇剖宫产的麻醉处理

<正>妊娠合并心衰是孕产妇死亡的常见病因,严重威胁着母婴安全,需要积极控制心衰的同时立即行剖宫产术终止妊娠。虽然现在麻醉水平、监测手段及产科诊疗水平已有显著提高,但术中风险仍然很大。2005-01—0212-01,我们共进行此类手术     

全身麻醉对剖宫产产妇分娩新生儿的影响

目的探讨剖宫产产妇实施全身麻醉对新生儿的影响。方法选择全身麻醉或硬膜外阻滞下行择期剖宫产产妇各30例，分别组成全身麻醉组和硬膜外阻滞组。全身麻醉组产妇先后静脉注射异丙酚2mg／kg、琥珀胆碱1．5mg／kg、并给予气管插管。麻醉维持：40％笑气＋60％氧气＋0．5MAC异氟醚，及维库溴铵0．08mg／kg，硬膜外阻滞组产妇应用1．73％碳酸利多卡因4ml＋5ml＋5ml（含1：200000肾上腺素）椎管内注入。两组分别于胎儿娩出后立即抽取新生儿脐动脉血进行血气分析，并记录两组新生儿出生后1d～5d的新生儿神经行为评分（NBNA）：新生儿行为能力、被动肌张力、主动肌张力、原始反射、一般状态。结果①血气分析：全身麻醉组新生儿pH值、二氧化碳分压（PaCO2）、氧分压（PO2）、动脉氧饱和度（SaO2）及碳酸氢根（HCO3^-）分别为7．21±0．08、（56．1±16．5）mmHg、（23．1±11．0）mmHg、（29．9±20．6）％、（19．1±3．4）（mmoL／L）。硬膜外阻滞组新生儿分别为7．37±0．06、（51．3±9．7）mmHg、（17．5±6．9）mmHg、（21．8±12．7）％、（21．6±3．3）（mmoL／L）。②NBNA：全身麻醉组第1d，2d，3d，5d的NBNA分别为（36．1±2．8）、（37．0±5．1）、（38．3±2．3）、（38．7±2．3）分。硬膜外阻滞组分别为（37．2±2．5）、（38．7±1．9）、（39．1±4．5）、（39．2±5．1）分。两组各项评分比较，差异均无统计学意义（P〉0．05）。结论剖宫产产妇采用常规剂量药物实施全身麻醉对新生儿安全无明显影响。     

妊娠合并肥厚性梗阻型心肌病行剖宫产术一例

患者 ,女 ,2 6岁 ,2 0 0 2年 9月 8日因停经 4 0 + 1周无产兆而入院 ,孕中偶有头晕、胸闷等症状 ,夜间能平卧入睡。 1999年曾出现双下肢无力 ,夜间入睡时心悸 ,晕厥一次 ,行检查示先天性心脏病 ,左室流出道狭窄 ,肺动脉压正常 ,但未予治疗。入院查体 :心率 75次 /分 ,血压 10 5 / 6 8mmHg ,心界左下扩大 ,胸骨左缘 3～ 4肋间闻及 4 / 6级喷射性收缩期杂音 ,屏气、运动时增强 ,双肺呼吸音清。心脏彩色超声 :先天性主动脉瓣下膜性狭窄 ,左房轻度扩大 ,左室流出道狭窄 ,宽13mm ,室间隔厚 19mm ,室间隔及左室壁弥散性增厚 ,室壁运动增强 ,左室…     

瘢痕子宫剖宫产的风险与麻醉处理

目的 探讨瘢痕子宫剖宫产手术产妇和围产儿的风险与麻醉处理.方法 瘢痕子宫剖宫产术100例,年龄24～43岁.硬膜外麻醉90例(A组),全身麻醉10例(B组).术中连续监测ECG、BP、HR、SpO_2;危重产妇监测CVP.记录切皮至胎儿娩出(I-D)时间、切开子宫至胎儿娩出(U-D)时间和新生儿Apgar评分.结果 A组硬膜外阻滞不全20例(22％).B组I-D时间短于A组L(7.5±2.0)min vs.(12.3±2.6)min](P<0.01).全组术中低血压32例(32％);新生儿窒息21例(21％);Apgar评分低于3分11例(死亡5例),4～7分10例,8～10分79例.产妇子宫次全切除2例、膀胱损伤修补1例、术中大量出血15例.结论 瘢痕子宫剖宫产手术产妇和新产儿的风险明显增加,硬膜外阻滞不全发生率较高,有效预防和正确处理高危因素是降低瘢痕子宫剖宫产产妇及新生儿并发症和死亡率的关键. gar评分.结果 A组硬膜外阻滞不全20例(22％).B组I-D时间短于A组L(7.5±2.0)min vs.(12.3±2.6)min](P<0.01).全组术中低血压32例(32％);新生儿窒息21例(21％ ;Apgar评分低于3分11例(死亡5例),4～7分10例,8～10分79例.产妇子宫次全切除2例、膀胱损伤修补1例、术中大量出血15例.结论 瘢痕子宫剖宫产手术产妇和新产儿的风险明显增加,硬膜外阻滞不全发生率较高,有效预防和正确处理高危因素是降低瘢痕子宫剖宫产产妇及新生儿并发症和     

Alagille syndrome and pregnancy: anesthetic management for cesarean section

A 34-year-old multiparous woman with a breech presentation, intrauterine growth restriction and premature rupture of membranes was transferred to our referral unit at 33 weeks of gestation. She was diagnosed with Alagille syndrome soon after birth because of cholestasis and pruritus. Her condition was later complicated by esophageal varices, treated with propranolol, thrombocytopenia, and insulin-dependent diabetes. She had characteristic facies, posterior embryotoxon, “butterfly” vertebrae but had no cardiac or renal abnormalities. Due to the early onset of spontaneous labor, emergency cesarean section under general anesthesia was performed 48 h after admission. This is the first case describing anesthetic care during delivery in a patient with Alagille syndrome. We discuss the anesthetic implications of the syndrome, emphasizing problems associated with portal hypertension and cholestasis, thrombocytopenia and cardiac abnormalities such as pulmonary artery stenosis.     

不同麻醉方式在肝炎后肝硬化孕妇剖宫产术中临床效果的比较

目的探讨和比较肝炎后肝硬化孕妇剖宫产术中全身麻醉与单次腰麻的临床效果。方法收集2010年6月至2016年6月首都医科大学附属北京地坛医院住院分娩的肝炎后肝硬化孕妇相关资料35例,肝硬化代偿期26例,失代偿期9例,年龄24~45岁,体重55~98kg,ASAⅡ或Ⅲ级。麻醉方式包括全身麻醉和单次腰麻,PLT低于50×109/L为全身麻醉(A组,n=15),静注丙泊酚1.5mg/kg,胎儿取出断脐后,行气管插管,术中持续泵入瑞芬太尼0.2μg·kg~(-1)·min~(-1)和TCI丙泊酚维持麻醉至手术结束;PLT高于50×10~9/L为单次腰麻(B组,n=20),选左侧卧位经L3~4间隙穿刺,见脑脊液后注入罗哌卡因10~15mg,10s注完。比较两组孕妇术前基本情况、术中出血量、手术时间、Apgar评分及不同麻醉方式下机体肝功、凝血功能等指标变化。非条件Logistic回归模型分析术后肝功能变化的影响因素。结果 A、B两组术中出血量、手术时间、Apgar评分、术后住院天数等情况差异无统计学意义。与术前比较,A组白蛋白(ALB)明显升高(P0.05);B组孕妇丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)明显升高(P0.01)。非条件Logistic回归分析显示,麻醉方式是术后总胆红素(TBIL)升高的危险因素(OR=12.04,95%CI 1.14~127.45),单次腰麻后TBIL升高的可能性明显大于全身麻醉。结论肝炎后肝硬化孕妇剖宫产术中,单次腰麻对肝功能的影响可能较全身麻醉显著。     

A parturient with neurofibromatosis type 2: anesthetic and obstetric considerations for delivery

Neurofibromatosis type 2 is an extremely rare form of neurofibromatosis characterized by central nervous system involvement with bilateral vestibular schwannomas and spinal tumors. Anesthetic management of a parturient with neurofibromatosis type 2 has not been fully reported, and the condition is challenging to obstetric anesthesiologists due to the presence of intracranial and intraspinal canal neurofibromas. We present a case of neurofibromatosis type 2 referred for delivery. Because of central neuraxial involvement, regional anesthesia was avoided, and the patient delivered by cesarean section under general anesthesia. The importance of pre-operative diagnosis and multidisciplinary management for neurofibromatosis type 2 is emphasized and anesthetic and obstetric considerations for delivery are presented.     

脊麻加微量吗啡对剖宫产患者细胞因子的影响

目的探讨脊麻加微量吗啡对剖宫产患者细胞因子的影响。方法30例择期剖宫产患者随机分成两组:Ⅰ组(20例),脊麻用药0.75%布比卡因1.8ml加吗啡0.2mg;Ⅱ组(10例),脊麻用药0.75%布比卡因1.8ml。分别于麻醉前(T0)、术后即时(T1)、24h(T2)、72h(T3)采集外周静脉血测定白细胞介素(IL)-6、IL-8、IL-10和肿瘤坏死因子α(TNF-α)。结果与T0相比,Ⅰ组T1时IL-6[(0.17±0.01)vs.(0.19±0.01)ng/ml]和IL-10[(30.91±5.86)vs.(36.48±7.63)ng/ml]均明显下降(P<0.05和P<0.01),Ⅱ组T1时IL-6明显下降(P<0.05)。T3时Ⅰ组IL-10显著低于Ⅱ组[(33.40±2.23)vs.(29.25±7.65)ng/ml](P<0.05)。两组患者TNF-α相比差异无统计学意义。结论脊麻加微量吗啡对剖宫产患者的细胞因子有轻度影响。     

Comparison of visceral pain incidence during cesarean section performed under spinal or epidural anesthesia

The incidence of visceral pain during cesarean section performed under regional anesthesia was studied in 80 unpremedicated patients. They were divided in two similar groups concerning age, weight and height. Group 1 consisted of 40 patients submitted to cesarean section under spinal anesthesia, while in group 2 (40 patients) epidural anesthesia was used. Surgery was totally painless for all patients of group 1 patients, whereas in group 2 intraoperative analgesia was complete for 11, good in 18 and fair in 10 patients. One patient of group 2 required general anesthesia due to excrutiating pain during exteriorization of uterus despite a seemly adequate lebel of cutaneous analgesia of T₆. The authors conclude that spinal anesthesia favorably compares with epidural anesthesia for cesarean section, because the incidence of visceral pain with the former was nill and because both techniques are equally safe for mothers and neonates.(Weksler N, Ovadia L, Stav A, et al.: Comparison of visceral pain incidence during cesarean section performed under spinal or epidural anesthesia. J Anesth 6: 69–74, 1992)     

General anesthesia for cesarean section in a Singapore maternity hospital: a retrospective survey

We conducted a retrospective study of all cases of cesarean section at the KK Women's and Children's Hospital over a one-year period from September 1, 2002 to August 31, 2003, with the aim of evaluating current anesthetic practice. These cases were identified using hospital databases and relevant data was extracted from clinical notes. There were 14244 deliveries during the study period with a cesarean section rate of 25.2% (3583 cases). Of these, 20.4% (732 cases) were performed under general anesthesia. Maternal request was the chief reason for general anesthesia, especially among elective cases. Regional block failure accounted for 16% of the general anesthesia cases performed or 4.0% of the total regional techniques attempted. Regional block failure rate was highest for emergency cases in which an indwelling labor epidural catheter was used to provide surgical anesthesia via a bolus top-up. General anesthesia still has a definite place for cesarean delivery despite the predominant use of regional techniques in our institution.