Saravanakumar Kanakarajan, Rao Sudarsan Gururaja, Cooper Griselda M
Specialist Registrar in Anaesthesia, Birmingham School of Anaesthesia, Birmingham Women's Hospital, Birmingham, UK.
Curr Opin Obstet Gynecol. 2006 Dec;18(6):631-5. doi: 10.1097/GCO.0b013e3280101019.
The aim of this article is to review the clinical challenges of obesity in obstetrics from the anaesthetist's viewpoint.
The prevalence of obesity continues to increase both in the community and on the labour ward. Women who have undergone bariatric surgery are also on rise. During pregnancy, obesity is associated with hypertensive disease (chronic hypertension and preeclampsia), diabetes mellitus (pregestational and gestational), respiratory disorders (asthma and sleep apnoea), thromboembolic disease, caesarean section and infections (primarily urinary tract infections, wound infections and endometritis). Obesity is a risk factor for anaesthesia-related maternal mortality. Obese women are not only at high-risk of airway complications, cardiopulmonary dysfunction, perioperative morbidity and mortality but also pose technical challenges. Obesity also influences the fetal outcomes. Increasing use of regional techniques contributes to the reduced anaesthesia-related maternal mortality. Preconception counselling, antenatal screening and anaesthetic assessment are strongly encouraged.
Effective communication and good teamwork between an anaesthetist and an obstetrician are essential for the care of obese parturients. A more liberalized use of regional techniques may be a means of further reducing the anaesthesia-related maternal mortality.
本文旨在从麻醉医生的角度探讨产科肥胖问题的临床挑战。
肥胖在社区和产房的患病率持续上升。接受过减肥手术的女性数量也在增加。孕期肥胖与高血压疾病（慢性高血压和先兆子痫）、糖尿病（孕前和孕期）、呼吸系统疾病（哮喘和睡眠呼吸暂停）、血栓栓塞性疾病、剖宫产及感染（主要是尿路感染、伤口感染和子宫内膜炎）相关。肥胖是麻醉相关孕产妇死亡的危险因素。肥胖女性不仅面临气道并发症、心肺功能障碍、围手术期发病率和死亡率的高风险，还带来技术挑战。肥胖也会影响胎儿结局。区域技术使用的增加有助于降低麻醉相关孕产妇死亡率。强烈建议进行孕前咨询、产前筛查和麻醉评估。
麻醉医生与产科医生之间有效的沟通和良好的团队合作对于肥胖产妇的护理至关重要。更广泛地使用区域技术可能是进一步降低麻醉相关孕产妇死亡率的一种方法。
