感染产妇麻醉管理的研究进展

Research progress on anesthetic management of the parturient with infection

孕产妇的感染临床上并非少见,包括各种病毒和细菌感染,对母体及胎儿都会造成威胁。诊断为感染的产妇,无论是分娩镇痛还是剖宫产麻醉,对麻醉医师而言都是一种挑战,最为顾虑的是椎管内麻醉或镇痛是否会增加中枢神经系统感染或神经损害的风险。目前没有针对感染及发热患者麻醉管理的通用指南,但已经证实感染和发热并非椎管内阻滞的绝对禁忌证,不过麻醉的实施仍需根据每一位产妇个体情况及致病微生物来权衡利弊。结合目前的证据,本文就临床常见几种类型的感染产妇其麻醉管理作一分析,重点是椎管内麻醉或镇痛的安全性。

Maternal infections,including a variety of viral or bacterial infections,are not rare clinically,which will all be a threat to maternal and fetus.A parturient diagnosed with infection is definitely a challenge to the anesthesiologist,whether labor analgesia or cesarean delivery.The most concern is that neuraxial analgesia/anesthesia may increase risks of the central nervous system infection or neurologic deficit.There are currently no universal guidelines of anesthetic management on patients with infection and fever,but it has now been well established that the presence of infection and fever is not the absolute contraindication of neuraxial anesthesia.Nevertheless,anesthetic performance should be based on an individual risk-to-benefit ratio,obstetrical indications,and pathogenic microorganism.In combination with the evidences,this paper is to discuss the anesthetic management for parturients with several common types of infection,and the safety of neuraxial analgesia/anesthesia will be highlighted.