Hawkins J L, Koonin L M, Palmer S K, Gibbs C P
Department of Anesthesiology, University of Colorado Health Sciences Center, Denver 80262, USA.
Anesthesiology. 1997 Feb;86(2):277-84. doi: 10.1097/00000542-199702000-00002.
Anesthesia-related complications are the sixth leading cause of pregnancy-related death in the United States. This study reports characteristics of anesthesia-related deaths during obstetric delivery in the United States from 1979-1990.
Each state reports deaths that occur within 1 yr of delivery to the Centers for Disease Control and Prevention as part of the ongoing Pregnancy Mortality Surveillance. Maternal death certificates (with identifiers removed) matched with live birth or fetal death certificates when available from 1979-1990 were reviewed to identify deaths due to anesthesia, the cause of death, the procedure for delivery, and the type of anesthesia provided. Maternal mortality rates per million live births were calculated. Case fatality rates and risk ratios were computed to compare general to regional anesthesia for cesarean section deliveries.
The anesthesia-related maternal mortality rate decreased from 4.3 per million live births in the first triennium (1979-1981) to 1.7 per million in the last (1988-1990). The number of deaths involving general anesthesia have remained stable, but the number of regional anesthesia-related deaths have decreased since 1984. The case-fatality risk ratio for general anesthesia was 2.3 (95% confidence interval [CI], 1.9-2.9) times that for regional anesthesia before 1985, increasing to 16.7 (95% CI, 12.9-21.8) times that after 1985.
Most maternal deaths due to complications of anesthesia occurred during general anesthesia for cesarean section. Regional anesthesia is not without risk, primarily because of the toxicity of local anesthetics and excessively high regional blocks. The incidence of these deaths is decreasing, however, and deaths due to general anesthesia remain stable in number and hence account for an increased proportion of total deaths. Heightened awareness of the toxicity of local anesthetics and related improvements in technique may have contributed to a reduction in complications of regional anesthesia.
在美国，麻醉相关并发症是妊娠相关死亡的第六大原因。本研究报告了1979年至1990年美国产科分娩期间麻醉相关死亡的特征。
作为正在进行的妊娠死亡率监测的一部分，每个州都向疾病控制和预防中心报告分娩后1年内发生的死亡情况。对1979年至1990年期间可获得的与活产或死胎证明相匹配的孕产妇死亡证明（去除标识符）进行审查，以确定麻醉导致的死亡、死亡原因、分娩程序以及所提供的麻醉类型。计算每百万活产的孕产妇死亡率。计算剖宫产分娩中全身麻醉与区域麻醉的病死率和风险比，以进行比较。
麻醉相关的孕产妇死亡率从第一个三年期（1979 - 1981年）的每百万活产4.3例降至最后一个三年期（1988 - 1990年）的每百万活产1.7例。涉及全身麻醉的死亡人数保持稳定，但自1984年以来，区域麻醉相关的死亡人数有所下降。1985年前，全身麻醉的病死率风险比是区域麻醉的2.3倍（95%置信区间[CI]，1.9 - 2.9），1985年后增至16.7倍（95% CI，12.9 - 21.8）。
大多数因麻醉并发症导致的孕产妇死亡发生在剖宫产的全身麻醉期间。区域麻醉并非没有风险，主要是因为局部麻醉药的毒性和过高的区域阻滞。然而，这些死亡的发生率正在下降，而全身麻醉导致的死亡人数在数量上保持稳定，因此在总死亡人数中所占比例增加。对局部麻醉药毒性的更高认识以及技术上的相关改进可能有助于减少区域麻醉的并发症。
