剖腹产的麻醉进展(双语).ppt

Introduction Anesthetic participation can also reduce the incidence 、 of cesarean deliveries [e.g. improving forcep/vacuum analgesia, increasing the success of multiple gestation vaginal births, reducing fetal head entrapment with intravenous nitroglycerin, and improving external cephalic version (ECV) success]. (麻醉在自然分娩中的参与同样可 以减少剖腹产率，比如为使用产钳时提供镇痛，提高复杂 分娩的成功率以及改善胎位不正回转术的成功率) Introduction Neuraxial techniques improve ECV success by relaxing the abdominal wall muscles, improving patient comfort, and allowing a more concerted attempt.（神经 阻滞可以松弛腹壁肌肉，提高病人舒适度，从而提高回 转术成功率） anesthesia (lidocaine 45 mg with fentanyl 10 μg) combined with uterine tocolysis (nitroglycerin 50 μg iv, wait 50 sec) has been associated with a high success rate (83%) for external cephalic version (ECV).（使用 45mg利多卡因+10ug芬太尼，同时用50ug硝酸甘油抑制 子宫收缩，可以使回转术成功率提高到83%） Does a Perfect Cocktail Exist（最佳药物组合）? The most recent evidence would suggest the following combinations are optimal: Hail Caesar: Anesthesia for Cesarean Delivery 剖腹产手术麻醉 Lawrence C. Tsen, M.D. 翻译：福建医科大学附属协和医院麻醉科规培住院医师 石磊 Introduction Associated with high maternal mortality（二十世纪前， 剖腹产由于产妇高死亡率，开展得并不多）until the turn of the 20th century, cesarean delivery now accounts for approximately one third of all births in developed countries （发达国家三分之一分娩通过剖腹产） This increase has resulted from improvements in surgical and anesthetic techniques, diminished use of forceps for extractions, fewer breech and multiple gestation vaginal deliveries, and greater use of repeat cesarean deliveries （得益于外科及麻醉技术的发展、产钳使用的减少、臀位和 复杂分娩的减少、以及二次剖腹产的发展）. Introduction The updated Practice Guidelines for Obstetrical Anesthesia from the ASA Task Force on Obstetrical Anesthesia observe that neuraxial techniques (spinal, epidural, CSE) are associated with improved maternal and fetal outcomes when compared to general anesthesia (GA) （观察到椎管内麻醉与全麻相比，对于产妇和胎儿有更好的预 后）, particularly in the presence of high body mass index and airway issue