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[麻醉并发症导致的孕产妇死亡。法国孕产妇死亡机密调查结果,2010 - 2012年]

[Maternal deaths due to anesthesia complications. Results from the French confidential enquiry into maternal deaths, 2010-2012].

作者信息

Chassard D

机构信息

Département d'anesthésie-réanimation, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69500 Bron, France.

出版信息

Gynecol Obstet Fertil Senol. 2017 Dec;45(12S):S54-S57. doi: 10.1016/j.gofs.2017.10.028. Epub 2017 Nov 6.

Abstract

Over the period 2010-2012, maternal mortality linked to anesthesia accounted for 2% of maternal deaths, with no significant change since 2007-2009. Of the 7 maternal deaths analyzed by the expert committee, anesthetic complications were in 5 cases the main cause of death: 4 attributed to direct causes related to anesthetic procedures during childbirth and 1 to indirect cause in connection with an ENT complication during pregnancy. The anesthetic causes of maternal mortality were for the 2010-2012 period: cardiac arrest under spinal anesthesia during caesarean section, local anesthetic intoxication with unsuccessful resuscitation after cardiac arrest without intralipid administration, acute respiratory distress syndrome in the postpartum period after pulmonary aspiration during caesarean section, cardiac arrest during caesarean section under general anesthesia in a context of non-Hodgkin lymphoma with mediastinal syndrome, unsuccessful endotracheal intubation in a context of cellulitis of the oral cavity floor. In two other cases, anesthetic complications were identified as associated causes of death, the primary cause being intracerebral hemorrhage stroke and pulmonary hypertension. In most of the cases analyzed over the period 2010-2012, anesthesia and resuscitation have been involved in the occurrence of maternal deaths, mainly through strategic errors in the management of patients with severe pathology before delivery, as well as through insufficient cardiac resuscitation duration after cardiac arrest.

摘要

在2010 - 2012年期间,与麻醉相关的孕产妇死亡占孕产妇死亡总数的2%,自2007 - 2009年以来无显著变化。在专家委员会分析的7例孕产妇死亡病例中,麻醉并发症在5例中是主要死因:4例归因于分娩期间与麻醉操作直接相关的原因,1例归因于与孕期耳鼻喉并发症相关的间接原因。2010 - 2012年期间孕产妇死亡的麻醉原因包括:剖宫产时脊髓麻醉下心脏骤停;局部麻醉药中毒,心脏骤停后未给予脂质乳剂复苏失败;剖宫产时肺误吸后产后急性呼吸窘迫综合征;非霍奇金淋巴瘤合并纵隔综合征患者在全身麻醉下行剖宫产时心脏骤停;口腔底部蜂窝织炎时气管插管失败。在另外两例中,麻醉并发症被确定为死亡的相关原因,主要原因是脑出血性中风和肺动脉高压。在2010 - 2012年期间分析的大多数病例中,麻醉和复苏参与了孕产妇死亡的发生,主要是通过分娩前重症患者管理中的策略性错误,以及心脏骤停后心脏复苏时间不足。

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