產(chǎn)科麻醉風(fēng)險(xiǎn)與防范(修改)

1、高危險(xiǎn)高危險(xiǎn)(1/1000)一般非常安全(1/100K)100,00010,0001,000100101每年死亡人數(shù)每年死亡人數(shù)1101001,00010,000100,0001,000,00010,000,000 蹦極登山遭遇事故的次數(shù)遭遇事故的次數(shù)潛水潛水化學(xué)生產(chǎn)特許飛行有計(jì)劃的有計(jì)劃的航班航班Europeanrailroads核電站核電站 醫(yī)療行業(yè)醫(yī)療行業(yè)醫(yī)療行業(yè)的危險(xiǎn)醫(yī)療行業(yè)的危險(xiǎn) Leape, L A systems analysis approach to medical error. Leape, L A systems analysis approach to medical

2、error. Journal of evaluation in clinical practice, 1995;3,213-22Journal of evaluation in clinical practice, 1995;3,213-22全國(guó)孕產(chǎn)婦死亡率變化趨勢(shì)（全國(guó)孕產(chǎn)婦死亡率變化趨勢(shì)（1/10萬(wàn)）萬(wàn)） 衛(wèi)生部孕產(chǎn)婦死亡監(jiān)測(cè)衛(wèi)生部孕產(chǎn)婦死亡監(jiān)測(cè)http:/www.parliament.uk/Anesth Analg 2006;103:646-649 Rene Heylen，et al/Acta Anesthesiologica Belgica 1997,48:175182 Rene He

3、ylen，et al/Acta Anesthesiologica Belgica 1997,48:175182 Acta Anaesthesiologica ScandinavicaVolume 50 Issue 2 Page 206 - February 2006Acta Anaesthesiologica ScandinavicaVolume 50 Issue 2 Page 206 - February 2006每分鐘都有一位母親死于妊娠每分鐘都有一位母親死于妊娠和分娩并發(fā)癥，每年有超過和分娩并發(fā)癥，每年有超過50萬(wàn)母親死亡（萬(wàn)母親死亡（WHO，2004a）。）。更有高達(dá)數(shù)百萬(wàn)母親殘疾更有

4、高達(dá)數(shù)百萬(wàn)母親殘疾。 每年兒童總死亡中，將近每年兒童總死亡中，將近400萬(wàn)是新生兒（萬(wàn)是新生兒（Lawn et al，2004）*其它直接原因包括其它直接原因包括: 子宮外孕、子宮外孕、栓塞、栓塞、麻醉原因麻醉原因* 間接原因包括間接原因包括: 貧血、瘧疾、貧血、瘧疾、心臟病心臟病 2005世界衛(wèi)生組織的報(bào)告世界衛(wèi)生組織的報(bào)告*Data From:2005年中國(guó)衛(wèi)生年鑒PRACTICE GUIDELINES FOR OBSTETRIC ANESTHESIA An Updated Report by the American Society of Anesthesiologists Task F

5、orce on Obstetric Anesthesia* (Last amended on October 18, 2006) PRACTICE GUIDELINES FOR OBSTETRIC ANESTHESIA An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia* (Last amended on October 18, 2006) PRACTICE GUIDELINES FOR OBSTETRIC ANESTHESIA An Updated

6、Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia* (Last amended on October 18, 2006) 充分鎮(zhèn)痛充分鎮(zhèn)痛盡少的運(yùn)動(dòng)阻滯盡少的運(yùn)動(dòng)阻滯0.1Rawal N. Anesthesiol Clin North America 2000, 18: 267-95.姚尚龍姚尚龍 中華麻醉學(xué)，中華麻醉學(xué)，2004,3:237-239，Clark A Am J obstet Gynecol, 1998, 179: 1527.Hawkins, Anesthesiology 1997;86:273第一代局麻藥酯類局麻藥第二代局麻藥酰胺類局麻藥1946年Astra公司合成利多卡因1989年研制羅哌卡因,1996年FDA批準(zhǔn)歐洲上市,1999年進(jìn)入中國(guó)市場(chǎng) Anaesthesia. 2004 ;59:988-92 Khaw KS，Anesthesiology. 2001;95:1346-50.De Negri P , Anesth Analg. 2004;99:45-8. Al-Khalaf B, Acta Neurochir (Wien). 2003