分娩镇痛患者在紧急剖腹产过程中的短暂意识障碍。

IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL
International Medical Case Reports Journal Pub Date : 2024-09-29 eCollection Date: 2024-01-01 DOI:10.2147/IMCRJ.S478976
Mingyu Xu, Chaoran Wu
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引用次数: 0

摘要

一位怀孕39周的患者入院待产,在宫口开至2厘米时实施了分娩镇痛。我们在腰椎间隙成功实施了 L2.3 硬膜外穿刺,并为她配备了自控硬膜外镇痛输液泵(100mL、10mL 1%罗哌卡因+50ug 舒芬太尼+89mL 生理盐水),负载量为 8mL,用于持续给药。连续输注 8 毫升/小时,患者控制镇痛(PCA)6 毫升/次,间隔 15 分钟。镇痛效果良好。随后40分钟左右,由于胎儿监护,胎心率变异减速伴晚期减速,最低降至85次/min,治疗后无好转,产科医生遂准备行紧急剖宫产术。麻醉师对患者进行了评估,然后选择了硬膜外麻醉。硬膜外剂量为 3 毫升 1%利多卡因+0.5%罗氏混合液,3 分钟后给药 7 毫升 1%利多卡因+0.5%罗氏混合液。给药期间,患者主诉头痛难忍,意识迅速丧失。立即组织抢救、清宫、加压给氧、气管插管准备、心肺复苏、心血管活性药物等。约1分钟后,患者意识恢复,反应平稳,生命体征平稳,测麻醉平面T8。患者手术顺利,术后随访无并发症。5 天后患者康复出院。此类病例较为罕见,尤其在剖宫产手术过程中尚未见报道,现予以公布,供大家参考。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Transient Consciousness Disorder During Emergency Cesarean Section in Patients with Labor Analgesia.

A patient who was 39 weeks pregnant was admitted to the hospital to be expecting labor and performed labor analgesia when the uterine orifice was opened to 2 cm. We successfully performed L2.3 epidural puncture in the lumbar space and equipped her with a self-controlled epidural analgesia infusion pump (100mL, 10mL 1% ropivacaine + 50ug sufentanil + 89mL normal saline) with a load of 8mL for continuous delivery. Continuous infusion of 8mL/h, patient controlled analgesia (PCA) 6 mL/ time at 15 minute intervals. The analgesic effect is good. In the following 40 minutes or so, due to fetal monitoring, fetal heart rate variation deceleration accompanied by late deceleration, the minimum was reduced to 85 times/min, and there was no improvement after treatment, and then the obstetrician prepared to perform an emergency cesarean section. The anesthesiologist evaluated the patient and then chose an epidural. The epidural dose was 3mL 1% lidocaine +0.5% rox mixture, and 7mL 1% lidocaine +0.5% rox mixture was administered 3 minutes later. During the administration, the patient complained of unbearable headache and rapid loss of consciousness. Immediate organization rescue, uterine dissection, pressure oxygen, preparation of tracheal intubation, cardiopulmonary resuscitation, cardiovascular active drugs, etc. After about 1 minute, the patient regained consciousness, responded smoothly, the vital signs were stable, the anesthesia plane T8 was measured. The patient's surgery went smoothly, and there were no complications during postoperative follow-up. They were discharged 5 days later. Such cases are relatively rare, especially during cesarean section surgery has not been reported, so it is published for everyone's reference.

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来源期刊
International Medical Case Reports Journal
International Medical Case Reports Journal MEDICINE, GENERAL & INTERNAL-
CiteScore
1.40
自引率
0.00%
发文量
135
审稿时长
16 weeks
期刊介绍: International Medical Case Reports Journal is an international, peer-reviewed, open access, online journal publishing original case reports from all medical specialties. Submissions should not normally exceed 3,000 words or 4 published pages including figures, diagrams and references. As of 1st April 2019, the International Medical Case Reports Journal will no longer consider meta-analyses for publication.
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