术前评分制在降低产科麻醉风险的临床研究

术前评分制在降低产科麻醉风险的临床研究【摘要】目的:探讨术前评分制在降低产科麻醉风险中的优越性。方法:总结近两年行剖宫产手术产妇6200例，术前全面了解各重要脏器病变严重程度及代偿能力，结合妊娠产妇病理生理进行评分，根据评分把产妇分为5个等级并与美国麻醉医师协会asa评估相对应，选择合适的麻醉方法、药物、监测及预防措施，并作相应的术前准备。结果:6200例产妇，2例转上级医院治疗。4620例产妇施行了硬腰联合麻醉，术中低血压者给予麻黄碱以及快速输液后血压正常，肌松、止痛好，麻醉效果满意。1424例施行了硬膜外麻醉，其中氯胺酮辅助用药60例。300例高血压患者施行两点穿刺置管法，血压波动<20%,效果满意。136例施行全身麻醉，其中5例产妇产后出血，进行子宫切除。30例产妇因宫缩乏力，给予宫腔填塞纱布或背带缝合或结扎子宫动脉，预后良好。这6200例手术，无一例产妇死亡和严重并发症的发生。新生儿娩出后即刻apgar评分，新生儿复苏 92例。结论对于高危妊娠产妇，对危险因素实行量化评分是选择合适的麻醉方法、做好充分的术前准备、降低产科麻醉风险、保障母婴安全的重措施。

【关键词】剖宫产;术前风险评分;麻醉

a clinical research about preoperative scoring system in reducing the risk of obstetric anesthesia

【abstract】 objective :to explore the superiority of

preoperative scoring system in reducing the risk of obstetric anesthesia. methods: we reviewed 6200 parturient who accepted uterine-incision delivery nearly two years. we got the messages about each vital organs disease severity and compensatory ability of parturient that accepted operation and combined with pregnancy mothers’ pathophysiological rating to give a mark. according to the score, the parturient were divided into 5 levels to correspond with american standards association of anesthesiologists’assessment. we chose suitable anesthetic methods, drug, monitoring system and preventive measures, and done the corresponding preoperative preparation. results: 2 parturient turned to higher authorities’ hospital in order to treat. 4620 parturient were performed combined spinal epidural anesthesia. hypotensive patients were given methamphetamine and rapid transfusion to maintain blood pressure. they became muscle relaxation, indolence, and got satisfactory effect of anesthesia. 1424 parturient implemented the epidural anesthesia, including 60 cases performing with auxiliary medicine of ketamine. 300 hypertension patients executed the epidural anesthesia with two-point puncture catheter

insertion. they’blood pressure fluctuated less than 20% of preoperation, and they got satisfactory effect of anesthesia. 136 parturient accepted the general anesthesia. among the total, 5 cases got postpartum hemorrhage and received hysterectomy, and 30 cases were given palace of uterine stuffiness gauze or shoulder straps suture or uterine artery ligation due to uterine inertia. they’prognosis were fine. maternal death and severe complications weren’t take place among the 6200 cases. neonatal apgar score was given instantly after childbirth, resuscitation of newborn were 92 cases. conclusion :with regard to high-risk pregnancy parturient, quantitative score about risk factors is an important measure to choose the appropriate anesthetic methods, make sufficient preoperative preoperation, reduce the risk of obstetric anesthesia, and ensure the maternal and infant safe.

【keywords】 uterine-incision delivery;preoperative scoring system;anesthesia

【中图分类号】r554【文献标识码】b【文章编号】

1005-0515(2011)01-0013-03

产科麻醉关系到母体和胎儿的安全，风险相对较大。且高危妊娠的早识别与预防术中并发症是麻醉处理中的关键。因此术前要熟