脊髓麻醉和重症妊娠高血压.ppt
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1、Spinal Anesthesia and Severe Gestational Hypertension,Dr. Alison Macarthur Department of Anesthesia University of Toronto,Outline,Review of population / current obstetric practices Methods of anesthesia for cesarean delivery (past / present) Suggestions for future practice,Classification of PIH,Inci
2、dence of Complicated Gestational Hypertension,Incidence of GH: (U.S. 1979 - 86) 26 / 1000 live births contrast this with other nations: 20.3 / 1000 live births (Taiwan 1993-97) 103 / 1000 live births (Turkey 1986) Incidence of severe disease: 5.2 / 1000 live births (U.S. 1986) 7.8 / 1000 live births
3、 (Taiwan 1993-7),Incidence of Gestational Hypertension,Incidence of eclampsia: 0.56 / 1000 live births (U.S.) 19 / 1000 live births (Turkey) Mortality: (U.S. 1979 - 92) 1.5 / 100,000 live births,Spinal anesthesia - introduction into practice,Obstetric anesthesiologists started using spinal anesthesi
4、a for cesarean delivery (1990s) in mild - moderate disease change from 1st to 2nd ed. Chestnuts Obstetric Anesthesia: “Some anesthesiologists consider spinal anesthesia contraindicated in preeclampsia because of the risk of severe hypotension.”,Old Evidence,Hood - Hemodynamic results,Epidural,Spinal
5、,Wallace - Hemodynamic results,Karinen - Fetal Outcome (Pulsatility index),New Evidence,SOAP 2001; A34,Spinal Anesthesia for Eclamptics,No. of antepartum eclamptic parturients requiring immediate delivery: 1505 / 1846 (81.5%) No. of cesarean deliveries: 1185 / 1505 (78.7%),Spinal Anesthesia for Ecla
6、mptics,Method of anesthesia for cesarean delivery: 915 / 1185 spinal anesthesia (77.2%) 270 / 1185 general anesthesia (22.8%),Spinal Anesthesia for Eclamptics,No. of deaths amongst women requiring LSCS delivery: 58 / 1505 (3.9%) total deaths = 176 / 1846 (9.5%) ,Spinal Anesthesia for Eclamptics,No.
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- 关 键 词:
- 脊髓 麻醉 重症 妊娠 高血压
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