产后出血的麻醉处理.pptxVIP

产后出血的麻醉处理第1页/共42页 DisclosureBD 科学咨询委员会成员 第2页/共42页 Tonight on the Labor Floor…30 yo G1P0 at 38 weeksbreech presentation; in active labor170 cm 86 kg, Mallampati IINPO for 11 hoursNo allergiesNo medical history第3页/共42页 In the Operating Room…18g IV, uneventful spinal anesthesiaHealthy baby born5 minutes later: continuous oozing in the fieldOB: “The tone is poor” Patient: “I feel dizzy”Vital signs: BP 80/49; HR 120s SaO2100% What will you do? 第4页/共42页 ObjectivesDEFINE Postpartum hemorrhageIDENTIFY Challenges of managementPREPARE Management based on evidence 第5页/共42页 Mortality from Postpartum HemorrhageOne woman every seven minutes…Potts M et al. Lancet 2010; 375: 1762-3第6页/共42页 1995 through 2004 PPH increased by 30% 2.9 % of all deliveries Blood transfusion 2.4 to 4.6 per 1000 (90% increase)Uterine atony: predictable only 40% of cases. Bateman B et al. Anesth Analg 2010; 110: 1368-73.The Epidemiology of Postpartum Hemorrhage in the United States第7页/共42页 Cardiac Arrest During Hospitalization For Delivery in the United States, 1998-20114,843 cases identifiedPostpartum hemorrhage: 1349 patients (27.9%), 55% survivalAmniotic fluid embolism: 645 patients (13.3%), 52.5% survivalMhyre J et al., Anesthesiology 2014 April. 第8页/共42页 United KingdomPostpartum HemorrhageMaternal Death66% of cases: substandard care 第9页/共42页 ObjectivesDEFINE postpartum hemorrhageIDENTIFY challenges of managementPREPARE for management based on evidence 第10页/共42页 Postpartum Hemorrhage DefinedQuantification of blood loss? 500 mL after vaginal delivery 1000 mL after cesarean delivery? We are bad at estimating blood lossCases that need transfusion?? RetrospectiveHemodynamic changes? ? Late signs in the pregnant patient ACOG Practice Guideline; Obstet Gynecol 2006. Bose P et al. BJOG 2006. Toledo P. Et al. Anesth Analg 2007.第11页/共42页 Major Postpartum HemorrhageEstimated blood loss of 2500 mL or moreTransfusion of 5 units of bloodTreatment of coagulopathyWise and Clark Curr Opin Anaest