分娩镇痛课件PPT

Chloroform a’ la reine
Dr Snow gave me the blessed chloroform and the effect was soothing, quieting and delightful beyond measure
分娩镇痛的历史
1855年： Religious acceptance
childbirth for the first time
分娩镇痛的历史
1933 : John Cleland – pain pathways 1943 : Hingson – Continuous caudal 1949 : Flowers - Continuous lumbar epidural 产科麻醉的黑暗时代在西方终于结束了！ 产科麻醉的黑暗时代在天朝仍然持续中……
Archbishop of Canterbury's daughter received chloroform for labor pains. He refused to criticize
1860-1940 : Dark ages of obstetric anesthesia
August Bier, Virginia Apgar 1900: Oskar Kreis , used spinal anesthesia for
1591年
Lady Euframe MacAlyane of Edinburgh, Scotland: was Burned at the Stake because asking for labor analgesia
分娩镇痛的历史
The modern era of childbirth analgesia began in 1847 when Dr J Y Simpson administered ether to a woman in childbirth, and later in the same year, chloroform
相关历史
圣经故事：伊甸园
原罪（Original Sin）
God punished Eve: “In sorrow thou shalt bring forth children.” Genesis 3:16
Formed the basis of 1800 years of opposition to pain relief in labor.
分娩镇痛
复旦大学附属中山医院麻醉科 薛张纲
有关分娩镇痛的争议
ALWAYS controversial ! “Birth is a natural process” Women should suffer!! Concerns for mother’s safety Concerns for baby Concerns for effects of pain scores obtained through the McGill Pain Questionnaire. Scores were collected from women in labor, patients in a general hospital clinic, and patients in the emergency department after accidents involving traumatic injury. Note the modest difference in pain scores between nulliparous women with and without prepared childbirth training. PRI, Pain rating index, which represents the sum of the rank values of all the words chosen from 20 sets of pain descriptors. (Modified from Melzack R. The myth of painless childbirth [The John J. Bonica Lecture]. Pain 1984; 19:321-37.)
Figure 1 (facing page). Sources of Pain during Labor and Maternal Physiological Responses. The pain of labor, caused by uterine contractions and cervical dilatation, is transmitted through visceral afferent (sympathetic) nerves entering the spinal cord from T10 through L1. Later in labor, perineal stretching transmits painful stimuli through the pudendal nerve and sacral nerves S2 through S4. Cortical responses to pain and anxiety during labor are plex and may be influenced by the mother’s expectations for her childbirth experience, her preparation (through education), the presence of emotional support, her age, and other factors. The perception of pain is increased by fear and anxiety. Coping behaviors may include verbalization and the need to move into various positions. She may be motivated to have a certain type of birthing experience, and these opinions will influence her judgment about pain management and other choices during labor and delivery. Maternal physiological responses to labor pain may influence maternal and fetal well-being and the progress of labor. Hyperventilation may induce hypocarbia. An increased metabolic rate increases ogen consumption. Increases in cardiac output and vascular resistance may increase maternal blood pressure. Pain, stress, and anxiety cause release of stress hormones such as cortisol and β-endorphins. The sympathetic nervous system response to pain results in a marked increase in circulating catecholamines, such as norepinephrine and epinephrine, that can adversely affect uterine activity and uteroplacental blood flow. Effective analgesia attenuates or eliminates these responses.
Chloroform a’ la reine
The inhalation lasted fifty-three minutes. The chloroform was given on a handkerchief in fifteen minim doses; the Queen expressed herself as greatly relieved by the administration
Queen Victoria was given chloroform by John Snow (1853) for the birth of her 8th child Prince Leopold and this did much to popularize the use of pain relief in labor