Pan Peter H, Moore Charles H, Ross Vernon H
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA.
J Clin Anesth. 2004 Sep;16(6):461-4. doi: 10.1016/j.jclinane.2003.10.006.
Serious maternal bradycardia and asystole in laboring parturients after combined spinal-epidural labor analgesia are rare. We report such a case in a morbidly obese laboring parturient after receiving combined spinal-epidural labor analgesia. The differential diagnosis, risk factors, potential contributing factors, and the successful management of the complications with our positive patient outcome are discussed. Even with the low dose of neuraxial drugs commonly administered in combined spinal-epidural labor analgesia, this case underscores the importance of vigilance, frequent monitoring, proper positioning, and rapid resuscitation with escalating doses of ephedrine, atropine, and epinephrine, all of which are essential in the presence of bradycardia or asystole in these patients.
在实施腰麻-硬膜外联合分娩镇痛后，分娩产妇出现严重的心动过缓和心搏骤停的情况较为罕见。我们报告了一例病态肥胖的分娩产妇在接受腰麻-硬膜外联合分娩镇痛后出现上述情况的病例。文中讨论了鉴别诊断、危险因素、潜在促成因素以及通过成功处理并发症而取得良好患者结局的情况。即使在腰麻-硬膜外联合分娩镇痛中通常使用低剂量的神经轴药物，该病例仍强调了保持警惕、频繁监测、正确体位以及使用递增剂量的麻黄碱、阿托品和肾上腺素进行快速复苏的重要性，所有这些在这些患者出现心动过缓或心搏骤停时都是必不可少的。
