产科大出血围术期麻醉管理进展

Advance in the anesthetic management for major obstetric hemorrhage

产科大出血可能危及围术期孕产妇的生命,其高效管理涉及多个学科,是一项复杂的临床紧急事件,需要团队协作才可完成.麻醉医师作为产科大出血救治团队的关键成员,一旦产科医师决定需要紧急手术时,麻醉医师就要积极配合,发挥自身的特长,仔细监测危重产科病症,做好出血评估及复苏处理,平时也应积极开展产科大出血管理的模拟训练.本文对产科大出血的定义及病因分析、药物及手术治疗、麻醉管理(包括麻醉前准备、失血性休克评估、麻醉方式的选择、血液管理、血细胞回收、凝血功能及血流动力学监测等方面)的进展进行综述,所得结论供参考.

Major obstetric hemorrhage(MOH)may endanger the life of maternal during the perioperative period.Its highly efficient management involves multidisciplinary co-operation and is a complex clinical emergency situation which needs teamwork to complete.Anesthesiologist,as the key member of the obstetric MOH management team,should actively cooperate with the obstetricians once they decide to perform an emergency procedure for the parturient.They should possess perfect skill in resuscitation and rich experiences for assessment of MOH.They also should be professional in monitoring and caring for the critically ill patient.Constantly simulation training also should be actively carried out for MOH.In this review,the definition and etiology of MOH,drug and surgical treatment,anesthesia management(including preparation before anesthesia,hemorrhagic shock assessment,choice of anesthesia methods,blood transfusion,blood cell salvage,coagulation function and hemodynamic monitoring)were reviewed,and the conclusions were just for references.