分娩镇痛关注问题.ppt

静脉镇痛药包括杜冷丁，芬太尼，布托啡诺 与硬膜外镇痛比较 硬膜外和静脉阿片药物对胎儿脐动脉血pH值影响 硬膜外 静脉用药 硬膜外和静脉阿片药物对胎儿脐动脉血 BE 影响 硬膜外 静脉用药 椎管镇痛和静脉阿片药物比较 静脉或肌注阿片类药物 镇痛效果不全 通过胎盘 副作用多： 恶心，呕吐，胃排空延迟 嗜睡 呼吸抑制 误吸 胎儿缺氧 椎管内镇痛 不依赖血液浓度 母婴安全 减少产妇神经内分泌改变 改善胎盘血流 大幅提高分娩镇痛率后胎儿结局 《无痛分娩中国行》石家庄数据 《无痛分娩中国行》石家庄数据 硬膜外镇痛促进哺乳 硬膜外镇痛 － 有利于胎儿 改善胎盘血流 减少内分泌紊乱 减少代谢紊乱 避免全身用药 镇痛完全 改善胎儿血气，减少死亡（中国行数据） 利于哺乳 Continuous spinal is not new. Some of us may have used it in the past. Amy Woods Case. SOAP debate. * Most OB patients will get relief from an epidural. A practical issue in OB.... Epidural failure rate varies with regions and institutions. At Parkland failure rate is probably 30-40% depending on how long it has been in. * * Most OB patients will get relief from an epidural. A practical issue in OB.... Epidural failure rate varies with regions and institutions. At Parkland failure rate is probably 30-40% depending on how long it has been in. * Most OB patients will get relief from an epidural. A practical issue in OB.... Epidural failure rate varies with regions and institutions. At Parkland failure rate is probably 30-40% depending on how long it has been in. * * * Most OB patients will get relief from an epidural. A practical issue in OB.... Epidural failure rate varies with regions and institutions. At Parkland failure rate is probably 30-40% depending on how long it has been in. * Most OB patients will get relief from an epidural. A practical issue in OB.... Epidural failure rate varies with regions and institutions. At Parkland failure rate is probably 30-40% depending on how long it has been in. * Most OB patients will get relief from an epidural. A practical issue in OB.... Epidural failure rate varies with regions and institutions. At Parkland failure rate is probably 30-40% depending on how long it has been in. * * Most OB patients will get relief from an epidural. A practical issue in OB.... Epidural failure rate varies with regions and institutions. At Parkland failure rate is probably 30-40% depending on how long it has be