先兆子痫病人的麻醉处理(双语).ppt

Anesthetic Management of the Preeclamptic Patient;Definitions定义;Prevention and Management of Seizures / Eclampsia癫痫/子痫发作的预防和管理;;No drug is superior at preventing eclampsia. Magnesium therapy can cause maternal morbidity and unpleasant side effects however.在防止子痫方面没有药物优于镁。然而镁治疗可引起产妇发病率和不愉快的副作用。 It has tocolytic properties that prolong labor and increase bleeding at delivery. It decreases fetal heart rate variability, depresses maternal and neonatal neuromuscular function, and can cause maternal respiratory depression and cardiac toxicity at high blood levels。它具有抗分娩特性：延长产程和增加分娩时出血。在血液中高浓度时，它能减少胎儿心脏心率变异性，抑制孕产妇和新生儿的神经肌肉功能，并能引起产妇呼吸抑制和心脏毒性。 ;;The number needed to treat to prevent a seizure (NNT) fell to 129 in severe preeclampsia, and the NNT fell to only 36 in severely preeclamptic women who had symptoms such as headache, visual disturbances or epigastric pain. Not all women with mild preeclampsia will need to receive magnesium sulfate therapy. 在重度子痫前期中，需要治疗以防止发作的人数下降到129，在伴有头痛，视力障碍或上腹部疼痛的严重先兆子痫的女性中需要处理以防止发作的人数下降到仅仅36人。不是所有的轻度子痫前期都需要硫酸镁治疗。 ;;Administer an additional 2 gram magnesium sulfate bolus.给予2克硫酸镁静脉推注 Monitor the fetus if possible, but realize that heart rate abnormalities are common during a seizure and usually resolve soon after the seizure is terminated. Do not intervene to deliver immediately unless abruption or cord prolapse has occurred。如果可能的话，监测胎儿，但认识到在癫痫发作期间心率异常是常见，所以常在发作终止后监测胎儿。不要立即干预让孕妇分娩，除非发生胎盘早剥或脐带脱垂 ;;Although eclampsia is an indication for delivery, it is not an indication for cesarean delivery. Consider whether induction is feasible or whether labor is already progressing。虽然先兆子痫是一种分娩指征，但它不是剖宫产的指征。须考虑诱导是否可行或是否产程已经在进展中 ;Anesthetic Management During Labor and Delivery 产程和分娩中的麻醉管理;2) trial of labor followed by an urgent or emergent cesarean for fetal or maternal reasons, 因为母体或婴儿的原因，试产后跟随的可能是急产或紧急剖宫产 3) and planned cesarean for the patient who is not a candidate to labor.为不合适自然分娩的产妇计划剖宫产。 All plans must take into account whether neuraxial techni