病态肥胖剖宫产的硬膜外麻醉分析

Analysis of Epidural Anesthesia in Morbid Obesity Cesarean Section

目的探讨病态肥胖孕妇剖宫产手术安全合理有效的麻醉方法和过程管理。方法分析某院2008年11月-2014年10月期间安全平稳完成的15例体重指数大于40的病态肥胖孕妇剖宫产术,对其进行术前合并症分析、麻醉方式的选择、术中麻醉措施分析、预防不良反应的麻醉管理、麻醉并发症的预防处理等硬膜外麻醉管理措施,进行回顾分析总结。结果 15例患者合并症多,术前都合并下肢水肿,其他合并症还包括妊娠期高血压疾病、妊娠期糖尿病、巨大儿、心功能衰竭等。经过术前针对合并症治疗,心肺功能调整管理,确定剖宫产时机;术中熟练穿刺,预防不良反应及麻醉并发症的预防处理等管理措施,15例病例麻醉效果完善、过程平稳,仅2例发生产后出血、2例新生儿抢救,术后并发症少于报道。结论围术期评估调整是麻醉平稳的保证;连续硬膜外麻醉是病态肥胖孕妇剖宫产适宜方法。

Objective To discuss the safe,reasonable and effective anesthetic method and process management of cesarean section for morbidobese pregnant women.Methods From November 2008 to October 2014,15 pregnant women with body mass index（BMI40） undergoing cesarean section were analyzed.The management measures of epidural anesthesia,such as prevention of adverse reactions,prevention and management of complications,were retrospectively analyzed and summarized.Results15 patients were complicated with edema of lower extremity before operation,and other complications included hypertensive disorder complicating pregnancy,gestational diabetes mellitus,macrosomia,heart failure and so on.After preoperative treatment of complications,management of cardiopulmonary function adjustment,determination of opportunity of cesarean section,skilled puncture during operation,prevention of adverse reactions and prevention and management of complications of anesthesia,15 cases had perfect anaesthesia effect,and the process was stable.There were only 2 cases of postpartum hemorrhage and 2 cases of neonatal rescue.The postoperative complications were less reported.Conclusion Perioperative evaluation and adjustment is the guarantee of stable anesthesia.Continuous epidural anesthesia is a suitable method for cesarean section of morbid obese women.