急诊剖宫产的麻醉选择和术中处理医学研究.ppt
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1、急诊剖宫产的麻醉选择和术中处理费敏2010-3-26DefinitionoAbdominaldeliveryasurgicalprocedurethatpermitsdeliveryoftheinfantthroughincisionsintheabdominalanduterinewall.CesareanSectionoCaedereSecooPompiliusII730BConotwidelyuseduntilthe1920sIndicationsforCesareanSectionoRepeatnSchedulednFailedattemptatvaginaldeliveryoDyst
2、ociaoAbnormalpresentationnTransverselienBreechnMultiplegestationoFetalstress/distressoDeterioratingmaternalmedicalillnessnPreeclampsianHeartdiseasenPulmonarydiseaseoHemorrhagenPlacentaprevianPlacentalabruptionCesareanSection60%unplannedoMoreextensiveperipartummonitoringoLowerthresholdforsurgicalinte
3、rventionWhatisanemergencyCaesareansection?-Category1&2GradeDefinition (at time of decision to operate)Category1ImmediatethreattolifeofwomanorfetusCategory2Maternalorfetalcompromise,notimmediatelylife-threateningCategory3NeedingearlydeliverybutnomaternalorfetalcompromiseCategory4Atatimetosuitthewoman
4、andmaternityteamCategory1IndicationoPlacentalabruptionouterineruptureocordprolapseoActivelybleedingplacentapraeviaoIntrapartumhemorrhageoPresumedfetalcompromisewithseverelyabnormalCTGand/orseverefetalacidosisThe30-minuteruleoamaximumdecision-to-deliverytimeof30minforCategory1situationAssociationofAn
5、aesthetistsofGreatBritainandIrelandandObstetricAnaesthesistsAssociation.Guidelinesforobstetricanaesthesiaservices;2005.HillemannsP,StraussA,HasbargenU,etal.Crashemergencycesareansection:decision-to-deliveryintervalunder30minanditseffectonApgarandumbilicalarterypH.ArchGynecolObstet2005;273:161165.oan
6、aesthetistinformeddeliveryPerianestheticEvaluationoAdirectedhistoryandphysicalexaminationoplateletcountoAnintrapartumbloodtypeandscreenforallparturientsreducesmaternalcomplicationsoPerianestheticrecordingofthefetalheartratereducesfetalandneonatalcomplicationsAdirectedhistoryandphysicalexaminationoMa
7、ternalhealthandanesthetichistoryoRelevantobstetrichistoryoAirwayandheartandlungexaminationoBaselinebloodpressureoBackexaminationwhenneuraxialanesthesiaisplannedorplacedPlateletcountoAroutineintrapartumplateletcountdoesnotreducematernalanestheticcomplicationsoSuspectedpreeclampsiaorcoagulopathyoEclam
8、ptic-plt80*109.l-1MoodleyJ,JjuukoG,RoutC.EpiduralcomparedwithgeneralanaesthesiaforCaesareandeliveryinconsciouswomenwitheclampsia.BritishJournalofObstetricsandGynaecology2001;108:37882.AspirationProphylaxisoclearliquidsupto2hbeforeinductionofanesthesiaoAfastingperiodforsolids68h(fatcontent?)oFurtherr
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- 急诊 剖宫产 麻醉 选择 处理 医学 研究