1、国外：产科全麻比例下降 椎管内麻醉比例增加国内：产科全麻比例增加 椎管内麻醉比例下降国外剖宫产率逐年上升，产科全麻总体比例下降剖宫产率产科全麻在急诊手术中所占比例较大1990050%100%yr5%20%46.5%19702010 2021年WTO：中国剖宫产率46.5%，全球最高 省妇幼剖宫产率：40.31%全麻剖宫产率约占总体剖宫产率10%危急重孕产妇增多%9505311861990死亡误吸困难气道术中知晓 产妇 新生儿 低Apgar评分Sandra LesageJ Can Anesth,2021 Curr Opin Anaesthesiol,2000 Schneck H,Scheller
2、 M BMJ,2021Anaesthesiol Clin,2021Goldszmidth EAnesthesiology,1997The laryngeal mask airway is effective(and probably safe)in selected healthy parturients for elective Cesarean section:a prospective study of 1067 cases LMA is effective and probably safe for elective Cesareselected patients when manag
3、ed by experienced LMA usersHan TH,et alCan J Anesth,2001Can J Anesth,2021 LMA在产科困难气道中的应用价值Anesth Analg,2021没有证据说明增加麻醉深度会增加胎儿死亡率Kay RobinsAnesth Analg,2021Journal of Pregnancy,2021Hawkins et al.Obstet Gynecol,2021 急诊产科全麻患者多为危重症产妇 44.4%产妇术后需转至CCU，需要更多生命支持GA is often required in high-risk ASA III and I
4、V patients with neurologic and cardiac disease总体而言，母/胎死亡率：全麻椎管内麻醉Journal of Pregnancy,2021 血浆蛋白结合率 脂溶性 解离程度 分子量 子宫血流灌注 胎盘对药物的代谢丙泊酚问世 硫喷妥钠面临挑战 Int J Obstet Anesth,2021 吸入性麻醉药物可产生剂量依赖性抑制子宫收缩 增加吸入药物浓度会导致子宫收缩乏力和出血的概率增加ED50：0.59 g/kgED95：1.34 g/kgInt J Obstet Anesth 2021J Can Anesth,2021Sandra LesageJ Ca
5、n Anesth,2021Sandra Lesage一般认为控制两个时间点可有效减少药物对胎儿的影响：麻醉诱导至胎儿娩出时间I-D时间1015min 子宫切开至胎儿娩出时间U-D时间3minChoice of anaesthetic agents for caesarean section:a UK survey of current practiceInt J Obstet Anesth 2021 Thiopental(93%)remains the induction agent of choice in the UK 58%would support a change to propof
6、ol for induction 15%use opioids during rapid-sequence induction 85%use nitrous oxide 53%use sevoflurane(51.6%)or desflurane(1.6%)for maintenance of anaesthesiaMurdoch H1,Scrutton M,Laxton CH 静脉快速诱导丙泊酚2mg/kg瑞芬太尼：首剂1g/kg，维持0.2g/kgmin顺阿曲库铵 吸入诱导麻醉机预充后，8%七氟醚8L/min病例1 静脉诱导丙泊酚2mg/kg瑞芬太尼：首剂1g/kg，维持0.2g/kgmi
7、nmg/kg 气管插管 麻醉维持瑞芬太尼：维持0.2g/kgmin 出胎后麻醉维持咪达唑仑3mg+舒芬太尼30g瑞芬太尼 0.15g/kgmin丙泊酚 6mg/kgh 术毕带气管导管送返MICU 新生儿Apgar评分：1min 9分 5min 10分 手术开始切皮至胎儿娩出时间3min病例2全身麻醉 吸入诱导麻醉机预充后，8%七氟醚8L/min瑞芬太尼：首剂1g/kg，维持0.2g/kgmin罗库溴铵mg/kg 气管插管 麻醉维持七氟醚0.81MAC瑞芬太尼：维持0.2g/kgmin 出胎后麻醉维持咪达唑仑3mg+舒芬太尼30g瑞芬太尼 0.15g/kgmin丙泊酚 6mg/kgh 新生儿Apgar评分：1min 4分 行气管插管送新生儿科 慎行、精准、协作、关爱依托生命，价值所在
