胎盘早剥麻醉英文版.ppt

A Case of Placental Abruption Anesthesia Name Basic Information Pregnant female 27y/o 75kg normal pregnancy for 38 weeks Medical history : After CEA L4-5 for clinical painless labour about 3 h in the ward, the obstetric doctors found a significant increase in vaginal bleeding Chief complaint: Severe abdominal pain with no relief after CEA Past history :The patient was healthy before Auxiliary record RBT: RBC 3.58 * 1012 / L, WBC 4.9 * 109 / L, Hb 95g / L, PLT 105 * 109/L Coagulation function test, 3P test (-) prothrombin time 11 seconds Ultrasound examination: an irregular liquid dark area of l.7cm * 4.5cm between the left and the lower part of the placenta and the uterine wall Pre-evaluation ASA:Ш Mallampati:Ⅱ Clear , pale Hypotention : BP 80/40 mmHg, HR 120 /min FHR: 110-120 bpm a moderate and a severe variation of the deceleration occurred about every 20 minutes to OR Anesthesia  GA: CEA no effect and hypotension Monitoring: Bp ECG SpO2 Established intravenous access, resuscitation immediately by rapid infusion of crystal solution about 1000-1500 ml Rapid induction intubation: 100% oxygen +etomidate 0.2 mg / kg+ rocuronium 40mg+remifentanil 2 μg/kg Intubation: general laryngoscope ,used the compression of the cricoid pressure Anesthesia  0.5%~0.8% sevoflurance ,until childbirth After childbirth: Propofol(TCI 1-2μg/ml+ remifentanil(0.2μg/kg·h) )+ Sevoflurane(0.5-0.8%) maintain BIS 40-60. At the end of surgery, neostigmine 0.07 mg/kg and granisetron 3mg When the patient was fully awake, pulled out the endotracheal tube Diagnosis  1. Placental abruption: (after the 20th week or during delivery) the separation of the placenta(in normal site)from the site of uterine implantation before delivery of the fetus 2.The early stage of shock:hypotention,pale 3.Fetal distress Evaluation and Analysis Timely termination of pregnancy to ensure the safety of mother and infant Timely expansion of v