美国与麻醉相关的产妇死亡率：1979-2002 年。

Anesthesia-related maternal mortality in the United States: 1979-2002.

机构信息

From the Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado; the Centers for Disease Control and Prevention, Atlanta, Georgia; the Oregon Anesthesiology Group, Portland, Oregon; and the Department of Anesthesiology, University of Florida School of Medicine, Gainesville, Florida.

出版信息

Obstet Gynecol. 2011 Jan;117(1):69-74. doi: 10.1097/AOG.0b013e31820093a9.

DOI:10.1097/AOG.0b013e31820093a9

PMID:21173646

Abstract

OBJECTIVE

To examine 12 years of anesthesia-related maternal deaths from 1991 to 2002 and compare them with data from 1979 to 1990, to estimate trends in anesthesia-related maternal mortality over time, and to compare the risks of general and regional anesthesia during cesarean delivery.

METHODS

The authors reviewed anesthesia-related maternal deaths that occurred from 1991 to 2002. Type of anesthesia involved, mode of delivery, and cause of death were determined. Pregnancy-related mortality ratios, defined as pregnancy-related deaths due to anesthesia per million live births were calculated. Case fatality rates were estimated by applying a national estimate of the proportion of regional and general anesthetics to the national cesarean delivery rate.

RESULTS

Eighty-six pregnancy-related deaths were associated with complications of anesthesia, or 1.6% of total pregnancy-related deaths. Pregnancy-related mortality ratios for deaths related to anesthesia is 1.2 per million live births for 1991-2002, a decrease of 59% from 1979-1990. Deaths mostly occurred among younger women, but the percentage of deaths among women aged 35-39 years increased substantially. Delivery method could not be determined in 14%, but the remaining 86% were undergoing cesarean delivery. Case-fatality rates for general anesthesia were 16.8 per million in 1991-1996 and 6.5 per million in 1997-2002, and for regional anesthesia were 2.5 and 3.8 per million, respectively. The resulting risk ratio between the two techniques for 1997-2002 was 1.7 (confidence interval 0.6-4.6, P=.2).

CONCLUSION

Anesthetic-related maternal mortality decreased nearly 60% when data from 1979-1990 were compared with data from 1991-2002. Although case-fatality rates for general anesthesia are falling, rates for regional anesthesia are rising.

LEVEL OF EVIDENCE

II.

摘要

目的

检查 1991 年至 2002 年 12 年间与麻醉相关的产妇死亡，并将其与 1979 年至 1990 年的数据进行比较，以评估随时间推移麻醉相关产妇死亡率的趋势，并比较剖宫产期间全身麻醉和区域麻醉的风险。

方法

作者回顾了 1991 年至 2002 年期间发生的与麻醉相关的产妇死亡。确定涉及的麻醉类型、分娩方式和死因。计算了每百万活产因麻醉相关的妊娠死亡率，定义为与麻醉相关的因妊娠导致的死亡除以百万活产。通过将全国剖宫产率乘以全国区域和全身麻醉比例，应用国家估计值来估计病死率。

结果

86 例与麻醉并发症相关的妊娠死亡，占总妊娠死亡的 1.6%。1991-2002 年，与麻醉相关的妊娠死亡率为每百万活产 1.2 例，比 1979-1990 年下降了 59%。死亡主要发生在年轻女性中，但 35-39 岁女性的死亡比例大幅上升。14%的分娩方式无法确定，但其余 86%的产妇正在接受剖宫产。1991-1996 年全身麻醉的病死率为每百万 16.8 例，1997-2002 年为每百万 6.5 例，区域麻醉分别为每百万 2.5 和 3.8 例。因此，1997-2002 年两种技术的风险比为 1.7（置信区间 0.6-4.6，P=.2）。