课件：剖宫产术后镇痛.ppt

硬膜外镇痛并发症 硬膜外导管放置有关的并发症 硬膜外血肿,发比例为1:1700~200,000（ Wang LP, et al. Anesthesiology 1999; 91: 1928-1936 ） 感染,发生率约为0.01-0.05%（Wang et al,1999） 导管脱落,发生率约为0.15-0.18%（Schug et al,1993） 硬膜外镇痛并发症 硬膜外用药相关的并发症 呼吸抑制:使用芬太尼和局麻药的PCEA呼吸抑制发生率约为0.3%（liu et al, 1998） 恶心和呕吐 尿储留 瘙痒 低血压,其发生率为6.8%（ liu et al,1998 ） 静脉镇痛泵优点 管理方便，并发症少，减少纠纷。（医患关系差多一事不如少一事） * 静脉镇痛泵缺点 1：效果不如硬膜外泵 2：费用较硬膜外泵高 3: 影响母乳喂养？ 短时间使用阿斯匹林和布洛芬不影响哺乳 芬太尼小于150ug 无影响 脂溶性药物的蓄积，常乳少于初乳 阿片药呈弱碱性，初乳的蓄积量少 * 美国儿科学会（ AAPC ）：吗啡、芬太尼和布托啡洛的使用不影响哺乳 英国国家药典（BNF）：治疗剂量的吗啡不影响新生儿 剖宫产后施行阿片类药全身镇痛，不影响哺乳 胡旭东,许洁玲,王雪莲等.硬膜外腔单次注射吗啡联合地佐辛静脉自控镇痛在剖宫产术中的临床研究[J].中国医师杂志,2014年z1期?65-67 * 现存问题 静脉镇痛泵效果的问题是目前存在的普遍问题，不仅仅是产科，多个科室反映镇痛效果不佳，主要原因是镇痛药物剂量不足，尤其是术后疼痛剧烈的手术如：骨科手术，开胸手术，大切口腹部手术 * THANK YOU SUCCESS * * 可编辑 * 250 patients who had undergone surgical procedures (in- and outpatient) in the past year completed a questionnaire about their experiences with pain before and after surgery. The most common concern that patients expressed prior to surgery was experiencing pain (59%), which was cited more often than concerns about whether the surgery would improve their condition (51%) or whether they would fully recover (46%). 58% of the sample reported pain prior to surgery. Despite receiving treatment for pain, 82% reported pain in the immediate postsurgical period (end of surgery up to 2 weeks after discharge) and 75% reported pain after discharge. More than two thirds of patients reported pain of moderate to severe intensity, and extreme pain was reported by 18% overall and 8% after discharge. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534-540. * 250 patients who had undergone surgical procedures (in- and outpatient) in the past year completed a questionnaire about their experiences with pain before and after surgery. The most common concern that patients expressed prior to surgery was experiencing pain (59%), which