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[孕期及分娩期间最常用的药物及其影响]

[Drugs most frequently used during pregnancy and labor and their effects].

作者信息

Barrat J, Seebacher J

出版信息

Ann Anesthesiol Fr. 1975;16 Spec No 1:9-19.

PMID:2086
Abstract

It is rather difficult to draw up a list of the drugs most frequently used during pregnancy, and to specify their action on the mother, the uterus ans the fetus bearing in mind the differences between them. This difficulty results in particular from the high number of drugs owing to: the frequency of prescriptions and selfmedication in the pregnant woman who suffers from numerous disorders, and the possibility of a pathology associated with the pregnancy or a pathology due to the pregnancy itself thereby defining the "high risk" pregnancy. On this background already modified by pregnancy, under the hold of numerous drugs, an anesthetic can be necessary in addition during labour or delivery, the frequency of which can be estimated as being approximately 20 per cent. It is not possible to study all therapeutic agents in a single communication. One can only evoke the influence of the most currently used drugs; analgesics, antibiotics, diuretics, sleeping tablets, anti-hypertensives and those aimed at the neuropsychiatric system (anti-depression agents, neuroleptics, tranquillizers) which are so frequently used at present. Finally, during labour the number of parturients who receive no drugs is rare: ocytocic and anti-spasmodic agents can also interfere with an anesthetic. All of these ideas which are more and more difficult to acquire are important to know. In fact the person in charge of the delivery must prescribe as little drugs as possible (in order to avoid multiple drug interference which is rather difficult to predict) knowing the possible action of drugs on the fetus (in order to allow best adaptation to life in our atmosphere after delivery) and foreseeing the possible necessity for an anesthetic. In his turn, the anesthetist should have a good knowledge of obstetrical physiology and pathology and the drugs capable of being used during pregnancy and labour in order to be able to choose the best adapted anesthetic. This emphasized the importance of a well integrated obstetrico-anesthetic team in which each member knows the problems of the other, with the aim of being the least possible noxious for the mother, and the future newborn, the fetus. This also emphasizes the necessity for anesthetists attached to the ostetrical unit, knowing like the obstetrician the histories of those women with "high risk" pregnancies. Obstetrical anesthetics cannot be improvised.

摘要

要列出孕期最常用药物的清单,并明确它们对母亲、子宫和胎儿的作用,同时考虑到它们之间的差异,是相当困难的。造成这种困难的原因尤其在于药物数量众多,这是由于:患有多种疾病的孕妇开具处方和自行用药的频率较高,以及存在与妊娠相关的病理状况或由妊娠本身导致的病理状况,从而界定了“高危”妊娠。在已经因妊娠而改变的这种背景下,在大量药物的作用下,分娩或接生时可能还需要麻醉,其频率估计约为20%。不可能在一次交流中研究所有治疗药物。只能提及当前最常用药物的影响;镇痛药、抗生素、利尿剂、安眠药、抗高血压药以及针对神经精神系统的药物(抗抑郁药、抗精神病药、镇静剂),这些药物目前使用非常频繁。最后,在分娩过程中,未用药的产妇很少见:催产素和抗痉挛药物也可能干扰麻醉。所有这些越来越难以掌握的知识都很重要。实际上,负责接生的人员必须尽可能少开药(以避免难以预测的多种药物相互作用),了解药物对胎儿的可能作用(以便让胎儿在出生后能更好地适应外界环境),并预见可能需要麻醉。反过来,麻醉医生应该充分了解产科生理学和病理学,以及孕期和分娩时可用的药物,以便能够选择最适合的麻醉方法。这凸显了一个良好整合的产科麻醉团队的重要性,团队中的每个成员都了解其他成员面临的问题,目的是对母亲、未来的新生儿和胎儿造成尽可能小的伤害。这也强调了产科病房配备麻醉医生的必要性,他们要像产科医生一样了解那些“高危”妊娠女性的病史。产科麻醉不能临时应付。

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