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Journal of Obstetric Anaesthesia and Critical Care最新文献

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Sequential organ failure assessment score for predicting outcome of severely ill obstetric patients admitted to intensive care unit 序贯器官衰竭评估评分预测重症监护病房产科重症患者的预后
Pub Date : 2021-07-01 DOI: 10.4103/joacc.joacc_15_21
U. Srivastava, Yogita Dwivedi, S. Verma, A. Kannaujia, S. Ambasta, Israel Lalramthara
Background and Aim: Severe maternal illness is a life-threatening condition for pregnant women and often requires admission into the ICU. The aim was to evaluate the performance of maximum sequential organ failure assessment (SOFA) score to predict the outcome of patients admitted to ICU. Material and Methods: This prospective study was done on 121 consecutive women with severe obstetric illness admitted to the ICU during one year. Basic demographic, obstetrical data, indication of admission to ICU and interventions done were noted. SOFA score was evaluated according to the worst score for each of its six components every 24 hr till discharge or death in ICU. The receiver-operator characteristic (ROC) curve was constructed to predict the outcome of ICU. For analysis, patients were categorized as survivors and non-survivors. Results: Out of 121 patients admitted, 65 survived and 56 died with mortality rate of 45.9%. There were no differences among survivor and non-survivor patients regarding demographic data, obstetrical data and interventions done, but anaemia and inadequate ante natal care was more common in non survivors. ICU utilisation rate of obstetric patients was 1.9%. Most patients were admitted due to obstetric causes (87.6%), mainly for hypertensive disorders (46%) and were post caesarean (84.29%). Total maximum SOFA scores were higher in non-survivors than in survivors (14.09 ± 5.53 vs 7.47 ± 4.58, P
背景和目的:严重的孕产妇疾病对孕妇来说是一种危及生命的疾病,通常需要进入重症监护室。目的是评估最大序贯器官衰竭评估(SOFA)评分的性能,以预测入住ICU的患者的预后。材料和方法:这项前瞻性研究是对121名连续一年入住ICU的产科重症妇女进行的。注意到了基本的人口统计学、产科数据、入住ICU的指征和所做的干预措施。SOFA评分根据其六种成分中每种成分的最差评分进行评估,每24小时一次,直到出院或在ICU死亡。构建受试者-操作者特征(ROC)曲线来预测ICU的结果。为了进行分析,将患者分为幸存者和非幸存者。结果:在121名住院患者中,65人存活,56人死亡,死亡率为45.9%。在人口统计数据、产科数据和干预措施方面,幸存者和非幸存者患者没有差异,但贫血和产前护理不足在非幸存者中更为常见。产科患者的ICU使用率为1.9%。大多数患者因产科原因入院(87.6%),主要是高血压疾病(46%)和剖腹产后患者(84.29%)。非幸存者的SOFA总分高于幸存者(14.09±5.53 vs 7.47±4.58,P
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引用次数: 0
Pseudodextrocardia delaying the diagnosis of peripartum cardiomyopathy 假右心延迟诊断围产期心肌病
Pub Date : 2021-07-01 DOI: 10.4103/joacc.joacc_27_21
A. Bandyopadhyay, N. Sahni, G. Kanth
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引用次数: 0
Airway changes before & after delivery-does labour has any effect on the modified mallampati score? 分娩前后的气道变化对改良的mallampati评分有影响吗?
Pub Date : 2021-07-01 DOI: 10.4103/joacc.joacc_89_20
A. Das, N. Sabharwal, M. Kumar
Background: Changes in modified mallampati grade occur with the progress of pregnancy, labor, and delivery due to various reasons. This could lead to unanticipated difficulties in airway management, especially if the parturient were to undergo a surgical procedure in the postpartum period. Our study aimed to evaluate the change in airway parameters after delivery in parturient undergoing lower segment cesarean section (LSCS) under spinal anesthesia. Materials and Methods: This study was conducted at Vardhaman Mahavir (VMMC) and Safdarjung Hospital over a period of 18 months. A total of 160 patients posted for either elective or emergency cesarean section under spinal anesthesia were enrolled in the study (80 in each group). Airway parameters including modified mallampati grade (MMPG) were measured at various time intervals – before cesarean section (T1) and 2 h (T2), 6 h (T3), 24 h (T4), 48 h (T5), and 72 h (T6) after delivery and analyzed statistically. Results: Changes in MMPG occurred in 71.25% of cases in the emergency group as compared with 40% of cases in the elective group (P = 0.0001). The mean MMPG was significantly higher from 2 h up to 72 h after LSCS in the emergency group (having more patients in active labor). (P = 0.0001). Maximum changes in MMPG occurred 6 h after delivery in both groups. Normalization of MMPG to its precesarean value occurred earlier in elective patients (P = 0.0005). An association was found between the duration of labor and normalization of changes in MMPG to its preoperative value (P = 0.023). Conclusion: Airway changes in pregnant women are seen to worsen after emergency LSCS under spinal anesthesia and are affected by prolonged labor. Therefore, the maternal airway should be reassessed after the delivery of the baby, for any surgical procedure thereafter.
背景:由于各种原因,改良mallampati分级随着妊娠、分娩和分娩的进展而发生变化。这可能会导致气道管理出现意想不到的困难,尤其是如果产妇在产后接受手术。本研究旨在评估腰麻下段剖宫产产妇分娩后气道参数的变化。材料和方法:本研究在Vardhaman Mahavir(VMMC)和Safdarjung医院进行,为期18个月。共有160名患者在脊柱麻醉下接受选择性或紧急剖宫产手术(每组80名)。在剖宫产前(T1)和分娩后2小时(T2)、6小时(T3)、24小时(T4)、48小时(T5)和72小时(T6)的不同时间间隔测量气道参数,包括改良mallampati分级(MMPG),并进行统计学分析。结果:急诊组有71.25%的病例发生MMPG变化,而择期组有40%的病例发生变化(P=0.0001)。急诊组在LSCS后2小时至72小时的平均MMPG显著升高(有更多的患者在积极分娩)。(P=0.0001)。两组MMPG的最大变化发生在分娩后6小时。择期患者MMPG正常化至术前值的时间较早(P=0.0005)。分娩持续时间与MMPG变化正常化至手术前值之间存在相关性(P=0.023)。因此,分娩后应重新评估母亲的气道,以便进行任何手术。
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引用次数: 1
Pregnancy in thalassemia, anesthetic implication and perioperative management- A narrative review 地中海贫血的妊娠、麻醉意义和围手术期管理——叙述性综述
Pub Date : 2021-07-01 DOI: 10.4103/joacc.joacc_77_21
Abhishek Singh, Karuna Sharma, V. Venkateswaran, A. Trikha
Advancement in the treatment of thalassemia has increased the life span of female patients, with the result that they are reaching the reproductive age group and expecting childbirth. Anesthesia is challenging in such patients due to ineffective erythropoiesis and multiple system involvement as a result of iron overload and chelation therapy. Careful management of the preconception phase, various conception strategies, and multidisciplinary management of pregnancy and childbirth can lead to a healthy and successful outcome of pregnancy. This review provides an overview of the pathophysiology and clinical manifestation of alpha and beta-thalassemia in pregnancy and its successful management. All available literature related to thalassemia was searched in major databases like PubMed, Embase, Scopus, and Google Scholar. Original articles, review articles, book chapters, guidelines, case reports, and correspondence were reviewed for pathophysiology, clinical manifestations, and anesthetic management of thalassemia during pregnancy with keywords like thalassemia, Cooley's anemia, thalassemia and pregnancy, anesthetic management of thalassemia, labor analgesia in thalassemia, and transfusion in thalassemia.
地中海贫血治疗方面的进展延长了女性患者的寿命,使她们达到了生育年龄并准备分娩。由于铁超载和螯合治疗导致的红细胞生成无效和多系统受累,麻醉在这类患者中是具有挑战性的。仔细管理孕前阶段,各种受孕策略,以及多学科的妊娠和分娩管理可以导致一个健康和成功的妊娠结局。本文综述了妊娠期α和β -地中海贫血的病理生理和临床表现及其成功治疗。在PubMed、Embase、Scopus和谷歌Scholar等主要数据库中检索了所有与地中海贫血相关的文献。以地中海贫血、库利贫血、地中海贫血与妊娠、地中海贫血的麻醉管理、地中海贫血的分娩镇痛、地中海贫血的输血等为关键词,对妊娠期间地中海贫血的病理生理、临床表现、麻醉管理等方面的文章、综述文章、书籍章节、指南、病例报告、通信进行综述。
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引用次数: 0
Implications of active infective endocarditis with pregnancy and its management 活动性感染性心内膜炎与妊娠的关系及其处理
Pub Date : 2021-07-01 DOI: 10.4103/joacc.joacc_10_21
P. Bhatia, D. Dwivedi, A. Gautam, Shalendra Singh
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引用次数: 1
A ten-year-old obstetric anaesthesia journal: Musings of an editor 一本有十年历史的产科麻醉杂志:一位编辑的沉思
Pub Date : 2021-07-01 DOI: 10.4103/joacc.joacc_86_21
A. Trikha
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引用次数: 0
“Too powerful to push”: A rise in “on demand” caesarean section “太强大了,无法推动”:“按需”剖腹产的增加
Pub Date : 2021-07-01 DOI: 10.4103/joacc.joacc_42_21
Ketan Parikh, S. Pandya
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引用次数: 0
Acute fatty liver of pregnancy leading to a delayed hepatic failure necessitating liver transplantation: A case report 妊娠期急性脂肪肝致迟发性肝衰竭需要肝移植一例报告
Pub Date : 2021-07-01 DOI: 10.4103/joacc.joacc_16_21
Patriot Yang, R. Sikachi, M. Gerasimov, J. Aronsohn, G. Palleschi
Acute fatty liver of pregnancy (AFLP) is a potentially fatal metabolic disorder in pregnant patients that requires urgent delivery and aggressive medical and aesthetic management of maternal complications associated with acute liver failure. A 41-year-old female (79 kg) G1P0 at 31 weeks gestation presented with nausea, vomiting, pruritus, and jaundice. A diagnosis of severe liver dysfunction secondary to AFLP was made. We proceeded with urgent delivery under general anaesthesia. The patient had an uncomplicated caesarean section and gave birth to female infant with Apgar scores of 7 and 8. The patient remained stable for the following 2 weeks, however, given the lack of further recovery of hepatic function, a transjugular liver biopsy was performed, revealing persistent AFLP. She received N-acetylcysteine infusion and 4 cycles of plasma exchange with no improvement. Over the next few days her mental status worsened and her liver functions further deteriorated. She was listed for a deceased liver donor transplant and underwent successful orthotopic liver transplantation. She was discharged on post-operative day (POD) 14 of liver transplant.
妊娠期急性脂肪肝(AFLP)是妊娠患者中一种潜在的致命代谢紊乱,需要紧急分娩,并对与急性肝衰竭相关的母体并发症进行积极的医学和美学治疗。一名41岁女性(79 kg)G1P0在妊娠31周时出现恶心、呕吐、瘙痒和黄疸。诊断为继发于AFLP的严重肝功能障碍。我们在全身麻醉下紧急分娩。患者进行了一次简单的剖腹产手术,生下了阿普加评分为7和8的女婴。患者在接下来的2周内保持稳定,但由于肝功能缺乏进一步恢复,进行了经颈静脉肝活检,显示持续的AFLP。她接受了N-乙酰半胱氨酸输注和4个周期的血浆置换,但没有任何改善。在接下来的几天里,她的精神状态恶化,肝功能进一步恶化。她被列为已故肝移植患者,并成功接受了原位肝移植。她在肝移植术后第14天出院。
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引用次数: 0
Failure of resuscitative hysterotomy to rescue peripartum cardiac arrest 恢复性剖宫术抢救围产期心脏骤停的失败
Pub Date : 2021-07-01 DOI: 10.4103/joacc.joacc_30_21
Isha Kunagpa, B. Sharma, P. Verma, S. Siwatch, G. Prasad, Kajal Sharma
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引用次数: 1
Taurine as an adjunct therapy for early left ventricular recovery in peripartum cardiomyopathy 牛磺酸辅助治疗围产期心肌病早期左心室恢复
Pub Date : 2021-01-01 DOI: 10.4103/joacc.JOACC_36_20
H. Zaki, M. Sweed, Rania M. Ali, M. Abdelhafeez
Background and Aims: The pathophysiology of peripartum cardiomyopathy is not fully understood. Despite standard medical therapy, both morbidity and mortality remain high. Restoration of inflammatory cytokine balance may hold promise for therapy. Taurine has a powerful immune-modulatory and anti-inflammatory in addition to positive inotropic effect. This study evaluates the effect of taurine infusion on clinical status, left ventricular function, circulating plasma levels of N-terminal brain natriuretic peptide and C-reactive protein in women with peripartum cardiomyopathy. Methods: Forty women with peripartum cardiomyopathy admitted postpartum to the ICU were randomly assigned to one of two groups (20 in each group): Group T received taurine infusion and Group C received normal saline infusion over 24 hours for 5 days. Both groups received standard heart failure therapy according the institutional treatment protocol. Results: In the taurine group on day 5, there was a significant reduction in LVEDD and LVESD and significant increase in LVEF. All patients had an improvement in LVEF of at least 10% and 5 patients had recovery of LVEF to ≥50% on day 5 while the other 15 patients had LVEF 45- 50%. In the control group on day 5, there was non-significant change in LVEDD, LVESD and LVEF and no patient had recovery of LVEF to ≥50% or showed improvement in LVEF more than 10%. NYHA functional class showed significant increase on day 5 in the taurine group compared to the control group. Seventeen patients (85%) in the taurine group showed improvement of the NYHA functional class at day 5. In contrast, only 2 patients (10%) in the control group showed improvement of NYHA functional class at day 5. Conclusion: Early addition of taurine infusion to standard heart failure therapy improves both; echocardiographic parameters and laboratory parameters but without clinically significant changes in women with peripartum cardiomyopathy.
背景与目的:围产期心肌病的病理生理机制尚不完全清楚。尽管有标准的药物治疗,发病率和死亡率仍然很高。恢复炎症细胞因子平衡可能为治疗带来希望。牛磺酸除了积极的肌力作用外,还具有强大的免疫调节和抗炎作用。本研究评价牛磺酸输注对围产期心肌病妇女临床状态、左心室功能、循环血浆n端脑钠肽和c反应蛋白水平的影响。方法:将40例产后入住ICU的围产期心肌病患者随机分为两组(每组20例):T组给予牛磺酸输注,C组给予生理盐水输注,持续5 d,持续24 h。两组患者均根据机构治疗方案接受标准心力衰竭治疗。结果:第5天牛磺酸组LVEDD、LVESD显著降低,LVEF显著升高。所有患者的LVEF至少改善10%,5例患者在第5天LVEF恢复到≥50%,其他15例患者的LVEF为45- 50%。对照组患者第5天LVEDD、LVESD和LVEF均无显著变化,无患者LVEF恢复≥50%或LVEF改善超过10%。与对照组相比,牛磺酸组的NYHA功能等级在第5天显着增加。牛磺酸组17例(85%)患者在第5天NYHA功能等级有所改善。相比之下,对照组只有2例(10%)患者在第5天NYHA功能等级改善。结论:在标准心力衰竭治疗中早期加入牛磺酸输注对两者均有改善;围产期心肌病妇女超声心动图参数和实验室参数无临床显著变化。
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引用次数: 1
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Journal of Obstetric Anaesthesia and Critical Care
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