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1、重视产科麻醉安全 减少麻醉并发症武汉大学中南医院王焱林1医学资料2医学资料PhysiologicalChangesDuringPregnancyWhataretheimplications?3医学资料AverageMaximumCVChanges血容量+35%血浆容量+45%Hb-20%plt-10to20%凝血因子+50to+75%CO+40%SV+30%HR+15%to30%SVR-15%4医学资料AverageMaximumPulmonaryChangesinPregnancy氧耗量+20to
2、+50%分钟通气量+50%TV+40%RR+15%PaO2+10%PaCO2-15%HCO3-15%FRC-20%5医学资料NSChangesinPregnancyCNS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30to50%6医学资料GIChangesinPregnancyPyloruspushedupandbackwardDecreasedmotilityIncreasedgastrin;decreasedpHGEsphincterincompetenceMorel
3、ikelyandmoreacidicaspirationMetoclopramide,sodiumcitrateH2blockerwillnotaffectacidAlreadyProduced7医学资料Renal&EndocrineChangesRBF+75to85%GFR+50%Cr0.5to0.6mg/dLBUN8to9mg/dLGlucosuria1to10gm/24hrProteinuria0.3g/day[Normal0.25g/day]Glucosetoleranceisimpaire
4、dIncreasedtotalT3&T4[freeT3&T4Unchanged]8医学资料UteroplacentalCirculation600–700mL/minattermNoautoregulation=directlyproportionaltomeanperfusionpressureacrosstheuterusUterinecontractionsdecreaseflowEphedrinedoesnotdecreaseuterinebloodflow9医学资料NerveBlocksI
5、n1880,HalstedandHall(U.S)reportedCocaineforperipheralnerveinjectionIn1885,CorningreportedprolongingtheeffectofCocainewithEsmarchbandageblockinglocalcirculation10医学资料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11医学资料Table1.MostCommonAdverseOutcomes*
6、AdverseOutcome%ofClaimsMedianPaymentRangeofPaymentDeath29$417,880$438-22,344,000NerveDamage19127,000489-13,395,750PermBrainDamage91,480,0587,400-44,776,000AirwayTrauma789,96143-2,625,000EyeDamage4145,90046-4,147,000InjurytoNewborn4829,0164,933-19,656,0
7、00Stroke3370,0008,750-30,967,685Pneumothorax375,600574-17,370,000BackPain338,5002,800-2,540,000Headache323,9701,096-1,089,000AspirationPneumonitis3350,000714-4,290,000MyocardialInfarction2258,0009,450-2,254,250Burn,thermal263,6405,580-2,875,000SkinReac
8、tion227,068608-1,360,000Awareness151,480924-1,050,000Meningitis1122,8505,700-1,080,000N=8495*Totalpaymentsbydefendants,excludinglegalcosts,adjustedto2007dollars2009ASA年会：RefresherCourse12医学资料布比卡因“心脏毒性”反应1979年报道bupicacaine的心脏毒性反应（心律失常，循环
