重度妊娠高血压综合征行剖宫产术麻醉处理.docVIP

重度妊娠高血压综合征行剖宫产术麻醉处理 　　[摘要] 目的 探讨重度妊娠高血压综合征行剖宫产手术的麻醉处理。 方法 选择重度妊娠高血压综合征行剖宫产术的患者40例，年龄21～35 岁，ASAⅡ～Ⅲ级，术前解痉、降压。对症治疗肺水肿及水、电解质平衡紊乱。术中密切呼吸、循环监测，常规吸氧。麻醉方式首选硬膜外麻醉，局麻药中不加肾上腺素，低浓度、小剂量控制麻醉平面T6以下。有硬膜外禁忌者选择全麻，麻醉诱导选用异丙酚+琥珀胆碱，麻醉维持用异氟醚。待新生儿娩出后使用芬太尼和维库溴铵。注意输液的种类和速度，使用扩血管药调整血压至术前的80%水平 ，保持血流动力学稳定，预防心、脑血管并发症。术后用镇痛泵镇痛48 h。记录新生儿娩出时Apgar 评分和母体相关并发症发生情况。 结果 所有40例患者麻醉手术过程顺利，新生儿 1 min Apgar 评分，10 分24例，9～7分13 例，5分以下3例，经处理后，5 min评分全部达到10 分。2周内所有患者安全出院。 结论 积极术前准备，正确的麻醉方式选择和用药、吸氧、适当补液、合理降压，新生儿抢救处理，术后镇痛等麻醉处理措施，有助于提高重度妊娠高血压综合征行剖宫产术时的母婴安全。 　　[关键词] 妊娠高血压综合征；剖宫产；母婴安全；麻醉处理 　　[中图分类号] R614 [文献标识码] A [文章编号] 1674-4721（2012）02（a）-0080-02 　　 　　Anesthetic management of severe hypertensive syndrome complicating pregnancy for cesarean section 　　TAN Xingzhong YUE Yongmeng WANG Qing 　　Department of Anesthesiology, Central Hospital of Bazhong City in Sichuan Province, Bazhong 636000, China 　　[Abstract] Objective To discuss the anesthetic management of severe hypertensive syndrome complicating pregnancy for cesarean section. Methods Chose 40 cases with severe hypertensive syndrome complicating pregnancy, age 21 to 35 years, ASA for Ⅱ-Ⅲ level, with severe hypertensive syndrome complicating pregnancy scheduled for cesarean section were studied. The convulsion and hypertension of patients was controlled preoperatively. Pulmonary edema and water, electrolyte imbalance was symptomatic treatment. Intraoperative close breathing, circulation monitoring, conventional oxygen. Anesthesia epidural anesthesia preferred way, in the local anesthetics, did not add adrenaline, low concentration, small dose control plane T6 under anesthesia. Choice the contraindication who had epidural anesthesia, narcotic induction chose propofol + succinylcholine, anesthesia with different maintain fluorine ether. Used after fentanyl and vecuronium amines when the new student childbirth went out. Pay attention to the type of infusion and speed, the use of expansion, the blood vessels to adjust blood pressure medicine preoperative 80% le