时间：2013年6月25  8：00

地点：南方医科大学附属南方医院产科会议室

今日主题：新生儿安全日

    由于今日是新生儿安全日，来自美国无痛分娩中国行的专家团队8时与学员会面后先行进入南方医院的手术室，做好准备工作。在手术室参观的过程中经历了一位前置胎盘、胎盘植入产妇的抢救全程。学员在产科会议室焦急的等待了2小时余，换来专家团队一堂生动的产后出血抢救的经验。

    产妇妊娠足月，有剖宫产史，前置胎盘，术中失血6000ml。在美国，高危孕妇进行剖宫产前会有新生儿医生、麻醉医师、产科医师会诊，必要时需要放射科医生一同参加，共同制定择期剖宫产的方案，充分做好术前准备，术前、术中给与孕妇高度的重视。麻醉医师术前看孕妇的同时需要了解孕妇的化验情况，需要记住孕妇的血红蛋白，不能只了解孕妇不贫血，有出血倾向的孕妇需要充分备血，并且通知备血室。术中抗生素的应用，麻醉医生负责医嘱何时应用抗生素，麻醉医生控制手术室的用药，抗生素于手术开始（开皮）1小时内应用。出血的产妇需要使用动脉管、静脉管、输血应用加温设备。产妇有凝血功能障碍的时候先不拔管，防止出现硬膜外血肿。术中出血多的产妇，应该备用两个吸引器。对于有多次分娩的产妇，术中出现产后出血，我们需要考虑是否进行输卵管结扎，应与产妇及其家属沟通。

    美国专家通过亲临现场的产科急救，结合美国的操作经验给我们充分分析了操作中的每一个细节。避免今后我们进行抢救过程中出现失误。

 

英文部分为美国专家对产科抢救的观点(部分内容）。

 

    This morning Dr. Tao and Dr. Wong visited a postpartum hemorrhage patient from 8:30 to 11:30. At the beginning of the operation, the patient was bleeding heavily, and lost about 6000 ml of blood. There were problems in getting the proper personnel to the patient, and there were many delays. Because of the delays and miscommunication, it took about 1 hour for the blood to be prepared properly. Only when the patient’s blood pressure was very low, did they then give the person a blood transfusion. The patient also lost consciousness, but they put an oxygen mask on her, which allowed her to regain consciousness.

For this situation, Dr. Wong says that there needed to be a conversation among the anesthesiology team, the blood transfusion team, and the surgery team. This will help to prevent these situations and reduce complications in patients. This conversation needs to be done before the operation, and preferably one day before.

    In America, the hospital staff is more prepared and knows who is responsible for taking care of the patient. They put this information on a sheet, and do this before anesthesia is used. After the procedure, the doctors are able to recall what medicine was used on the patient. This is different than in China.

    Antibiotics were also improperly used on this patient. Antibiotics must be given one hour before making an incision on the patient. Furthermore, because 6000ml of blood was lost, the patient also should have given more antibiotics.

    Dr. Tao also noticed that the general anesthesia machine and equipment was not prepared. The anesthesiologist was still trying to proper assemble the machine.

    For this patient, the blood transfusion was done using cold blood. Using cold blood during blood transfusions can lead to an increased risk of clotting. Therefore the blood should have been transfused at a warmer temperature.

    The doctors also tried to stop the bleeding by extracting the patient’s placenta. However this actually leads to an increase of blood loss.

    For this situation, there was a lack of preparation and communication. The hospital staff needed to realize that the patient was at higher risk for postpartum hemorrhage because she already had other cesarean section operations. Thus, they should have prepared by taking an MRI scan, and talking to the blood bank ahead of time. 

Then the hospital staff should have prepared to have the patient deliver her baby at 34-35 weeks, to avoid having the patient go into spontaneous labor.

    Patients who have undergone previous Cesarean section operations are at higher risk for Placenta Previa and morbidity.

 

    通过专家的总结，学员与专家之间产生了共鸣，并展开热烈的讨论。答疑视频请关注中国妇产科网视频专区无痛分娩中国行专栏。

图为专家根据现场提问的问题进行针对性的讲解。