Stamer U M, Stuber F, Wiese R, Wulf H, Meuser T
Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Germany.
Int J Obstet Anesth. 2007 Oct;16(4):328-35. doi: 10.1016/j.ijoa.2007.05.011. Epub 2007 Aug 14.
We assessed current practice regarding indications and contraindications to regional analgesia and anaesthesia for labour and delivery in Germany.
Questionnaires were mailed to the directors of 918 German departments of anaesthesiology.
A total of 397 completed replies were received representing 41.3% of all deliveries in Germany. More than half of the respondents never perform spinal or epidural anaesthesia when the platelet count falls below 65x10(9)/L. Preeclampsia, which was not graded for severity, was considered an absolute contraindication to regional block by 15% and placenta praevia by 30% of respondents. If a woman had taken aspirin three days before, the numbers of respondents considering epidural anaesthesia contraindicated (40.2%) were nearly double those considering spinal anaesthesia contraindicated (21.7%) (P<0.001). For a platelet count of 79x10(9)/L, epidural anaesthesia was thought to be contraindicated by 37% and spinal anaesthesia by 22.2% (P=0.001). In departments with <500 deliveries/year, reluctance to use regional blockade was more pronounced than in departments with >1000 deliveries/year.
Clinical practice varies considerably in Germany. Concerns regarding the use of regional blockade were more prevalent in hospitals with small delivery units. Indications and contraindications are not consistent in Germany and some recommendations or guidelines are needed.
我们评估了德国目前关于分娩时区域镇痛和麻醉的适应证及禁忌证的应用情况。
向918名德国麻醉科主任邮寄了调查问卷。
共收到397份完整回复，占德国所有分娩量的41.3%。超过半数的受访者表示，当血小板计数低于65×10⁹/L时，从不进行脊髓或硬膜外麻醉。15%的受访者认为未分级的子痫前期是区域阻滞的绝对禁忌证，30%的受访者认为前置胎盘是区域阻滞的绝对禁忌证。如果女性在三天前服用了阿司匹林，认为硬膜外麻醉禁忌的受访者数量（40.2%）几乎是认为脊髓麻醉禁忌的受访者数量（21.7%）的两倍（P<0.001）。对于血小板计数为79×10⁹/L的情况，37%的受访者认为硬膜外麻醉禁忌，22.2%的受访者认为脊髓麻醉禁忌（P=0.001）。在年分娩量<500例的科室中，对使用区域阻滞的顾虑比年分娩量>1000例的科室更为明显。
德国的临床实践差异很大。在分娩量小的医院中，对区域阻滞使用的顾虑更为普遍。德国的适应证和禁忌证并不一致，需要一些建议或指南。
