肥胖症对孕产妇分娩镇痛及麻醉的影响  

Effects of maternal obesity on labor analgesia and anesthesia

作　　者：魏佳文 徐爱群 Wei Jiawen;Xu Aiqun(Department of Obstetrics,Yantai Affiliated Hospital of Binzhou Medical University,Binzhou 256600,Shandong Province,China)

机构地区：[1]滨州医学院烟台附属医院产科,滨州256600

出　　处：《中华妇幼临床医学杂志（电子版）》2022年第3期249-254,共6页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家自然科学基金资助项目(81702029)。

摘　　要：肥胖症(obesity)已成为全球性健康问题,孕产妇肥胖不仅导致产科并发症发生率增高,而且导致实施分娩镇痛及麻醉的风险和难度也随之增高。因此,建议对所有符合肥胖症诊断标准的孕产妇,应进行产前麻醉咨询。目前,用于经阴道分娩椎管内阻滞镇痛的方法包括:蛛网膜下腔-硬膜外联合阻滞麻醉(CSEA)、硬脊膜穿破硬膜外阻滞麻醉(DPEA)、硬膜外阻滞麻醉(EA)及连续脊椎麻醉(SA)技术。DPEA作为CSEA的替代技术,成为目前肥胖症孕产妇经阴道分娩镇痛的一种主流选择方案。肥胖症孕产妇剖宫产术分娩镇痛的椎管内麻醉方式,主要采用单次性SA或CSEA。目前CSEA是肥胖症孕产妇剖宫产术分娩镇痛的首选麻醉方式,但是在紧急情况下,也可选用气管插管全身麻醉。笔者拟就肥胖症孕产妇围生期管理、产时镇痛或麻醉及产褥期护理的最新研究进展进行阐述。Obesity has become a global health problem.Maternal obesity not only cause higher incidence of obstetric complications,but also have more risks and difficulties in implementing labor analgesia and anesthesia.Therefore,it is suggested that maternal obesity should carry out prenatal anesthesia consultation.At present,the methods for intraspinal block analgesia in vaginal delivery include combined spinal-epidural anesthesia(CSEA),dural puncture epidural anesthesia(DPEA),epidural anaesthesia(EA)and continuous spinal anesthesia(SA).As an alternative technique of CSEA,DPEA has become a popular choice for vaginal analgesia delivery in obese pregnant women.Intraspinal anesthesia for cesarean section mainly adopts single SA or CSEA.At present,CSEA is the preferred anesthesia for cesarean section in obese pregnant women and puerperae,but general anesthesia with endotracheal intubation can also be used in emergencies.The author intends to elaborate on the latest research progresses in perinatal management,intrapartum analgesia or anesthesia and postpartum care of maternal obesity.

关 键 词：肥胖症 镇痛 产科 剖宫产术 人体质量指数 镇痛 硬膜外 蛛网膜下腔-硬膜外联合阻滞麻醉 硬脊膜穿破硬膜外阻滞麻醉 麻醉 脊椎 孕产妇 

分 类 号：R714.3[医药卫生—妇产科学]