重视产科麻醉安全减少麻醉并发症.pptxVIP

重视产科麻醉安全减少麻醉并发症第1页/共84页 2Physiological Changes During PregnancyWhat are the implications?第2页/共84页 3Average Maximum CV Changes血容量 +35%血浆容量 +45%Hb -20%plt -10 to 20%凝血因子 +50 to +75%CO +40%SV +30%HR +15% to 30%SVR -15%第3页/共84页 4Average Maximum Pulmonary Changes in Pregnancy氧耗量 +20 to +50%分钟通气量 +50%TV +40%RR +15%PaO2 +10%PaCO2 -15%HCO3 -15%FRC -20%第4页/共84页 5NS Changes in PregnancyCNS 抑制MAC 减少达 60%肺误吸危险增加硬膜外或蛛网膜下腔麻醉局麻药剂量减少30 to 50%第5页/共84页 6GI Changes in PregnancyPylorus pushed up and backwardDecreased motilityIncreased gastrin; decreased pHGE sphincter incompetenceMore likely and more acidic aspirationMetoclopramide, sodium citrateH2 blocker will not affect acid Already Produced第6页/共84页 7Renal Endocrine ChangesRBF +75 to 85%GFR +50%Cr 0.5 to 0.6 mg/dLBUN 8 to 9 mg/dLGlucosuria 1 to 10 gm/24 hrProteinuria 0.3 g/day [Normal 0.25 g/day]Glucose tolerance is impairedIncreased total T3 T4 [free T3 T4 Unchanged]第7页/共84页 8Uteroplacental Circulation600 – 700 mL/min at termNo autoregulation = directly proportional to mean perfusion pressure across the uterusUterine contractions decrease flowEphedrine does not decrease uterine blood flow第8页/共84页 9Nerve BlocksIn 1880, Halsted and Hall (U.S)reported Cocaine for peripheral nerve injection In 1885, Corning reported prolonging the effect of Cocaine with Esmarch bandage blocking local circulation第9页/共84页 10产科麻醉的并发症全脊髓麻醉神经损伤局麻药毒性反应 误入硬膜下间隙导管折断异常广泛阻滞硬膜穿破和头痛第10页/共84页 11Table 1. Most Common Adverse Outcomes*Adverse Outcome % of Claims Median Payment Range of PaymentDeath 29 $ 417,880 $ 438 - 22,344,000Nerve Damage 19 127,000 489 - 13,395,750Perm Brain Damage 9 1,480,058 7,400 - 44,776,000Airway Trauma