重视产科麻醉安全减少麻醉并发症

1、.医学资料1武汉大学中南医院 王焱林.2医学资料.3医学资料.4医学资料.5医学资料.8医学资料.9医学资料.10医学资料.11医学资料Table 1. Most Common Adverse Outcomes*Adverse Outcome % of Claims Median Payment Range of PaymentDeath 29 $ 417,880 $ 438 - 22,344,000Nerve Damage 19 127,000 489 - 13,395,750Perm Brain Damage 9 1,480,058 7,400 - 44,776,000Airway Tra

2、uma 7 89,961 43 - 2,625,000Eye Damage 4 145,900 46 - 4,147,000Injury to Newborn 4 829,016 4,933 - 19,656,000Stroke 3 370,000 8,750 - 30,967,685Pneumothorax 3 75,600 574 - 17,370,000Back Pain 3 38,500 2,800 - 2,540,000Headache 3 23,970 1,096 - 1,089,000Aspiration Pneumonitis 3 350,000 714 - 4,290,000

3、Myocardial Infarction 2 258,000 9,450 - 2,254,250Burn, thermal 2 63,640 5,580 - 2,875,000Skin Reaction 2 27,068 608 - 1,360,000Awareness 1 51,480 924 - 1,050,000Meningitis 1 122,850 5,700 - 1,080,000N=8495 *Total payments by defendants, excluding legal costs, adjusted to 2007 dollars2009 ASA 年会：年会：R

4、efresher Course.12医学资料Albright GA. Anesthesiology 1979; 15 285-287.13医学资料.14医学资料.15医学资料.16医学资料nAn in-depth analysis of claims for nerve injury 1990-227 cases 1999-610 cases.17医学资料神经损伤神经损伤n脊髓损伤脊髓损伤n9090年代占赔偿案例年代占赔偿案例25%25%n8080年代占赔偿案例年代占赔偿案例10%10%n7070年代占赔偿案例年代占赔偿案例5%5%n区域麻醉导致神经损伤的最常见原因是椎管内血肿区域麻醉导致神经

5、损伤的最常见原因是椎管内血肿spinal or epidural hematoma (43/103 cases; 41%).n4343例赔偿案例中例赔偿案例中, 32 (74%) 与凝血异常有关与凝血异常有关 either from anticoagulant therapy (30 cases) or intrinsic coagulopathy(2 cases).18医学资料Ruppen W, et al. Anesthesiology 2006; 105(2): 394-9.19医学资料-Davies JM, et al. Anesthesiology 2009;110(1):131-9

6、.20医学资料-Davies JM, et al. Anesthesiology 2009;110(1):131-9.21医学资料瑞典1990-1999：450000例epidural发生严重神经损伤127例.22医学资料2000年法国12例（9女3男）椎管内阻滞后发生严重且持续时间长的神经根和脊髓并发症Anesth Analg 2007;104:975979.23医学资料.24医学资料Denise Wedel: 2003 ASA Refresher course lectures.25医学资料.26医学资料.27医学资料Denise Wedel: 2003 ASA Refresher cou

7、rse lectures.28医学资料.29医学资料.30医学资料Denise Wedel: 2003 ASA Refresher course lectures.31医学资料.32医学资料.33医学资料.34医学资料.35医学资料.36医学资料.37医学资料.38医学资料.39医学资料.40医学资料.41医学资料.42医学资料.43医学资料.44医学资料.45医学资料.46医学资料.47医学资料.48医学资料.49医学资料.50医学资料Vandermeulen E. Best Pract Res Clin Anaesthesiol 2010; 24(1): 121-31.51医学资料Vand

8、ermeulen E. Best Pract Res Clin Anaesthesiol 2010; 24(1): 121-31.52医学资料Vandermeulen E. Best Pract Res Clin Anaesthesiol 2010; 24(1): 121-31.53医学资料.54医学资料.55医学资料.56医学资料.57医学资料.58医学资料.59医学资料.60医学资料.61医学资料.62医学资料.63医学资料Rosalia Perez-Castro, Anesth Analg 2009,108:997-1007.64医学资料Pollock JE. Transient neurologic symptoms:etiology,riskfactors,and managementReg Anesth Med 2002;27:5816.65医学资料Johnson ME.Potential neurotoxity of spinal anesthesia with lidocaine. Mayo Clin Proc 2000;75:921-32.66医学资料Rosalia Perez-Castro Anesth Analg 2009,108:997-1007.67医学资料.68医学资料.69医学资料.70医学资料