分娩和围产期的子宫收缩剂、硫酸镁和抗生素:麻醉师的重要产科药物。

M. Astete , H.J. Lacassie
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摘要

产妇死亡的主要原因是合并症、妊娠高血压综合征、产科大出血和产妇败血症。因此,子宫收缩剂、硫酸镁和抗生素是在分娩和围产期管理产科病人的重要工具。这些药物被所有科室的麻醉医师广泛使用,在治疗和患者安全方面发挥着至关重要的作用。为了撰写这篇叙述性综述,我们对医学数据库进行了详细的检索,并选择了描述在妊娠、分娩和围产期病人中使用这些药物的研究。子宫收缩剂,尤其是催产素,在预防和治疗产后大出血方面发挥着重要作用,多项研究表明,在产科手术(如计划剖腹产和紧急剖腹产)中,使用比迄今为止公认的剂量更低的剂量即可达到效果。我们还讨论了卡贝缩宫素的使用,它是一种有效的替代品,在某些临床情况下具有治疗优势。硫酸镁是预防和治疗子痫的金标准,对早产儿也有神经保护作用。我们介绍了服用镁剂期间的注意事项。最后,我们讨论了了解微生物学和抗生素药理学在产科感染和子宫内膜炎治疗中的重要性,并提请注意分娩和剖腹产中抗生素治疗的最新趋势。
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Uterotonics, magnesium sulphate and antibiotics during childbirth and peripartum: Important obstetric drugs for the anaesthesiologist

The main causes of maternal mortality are comorbidities, hypertensive pregnancy syndrome, obstetric haemorrhage, and maternal sepsis. For this reason, uterotonics, magnesium sulphate, and antibiotics are essential tools in the management of obstetric patients during labour and in the peripartum period. These drugs are widely used by anaesthesiologists in all departments, and play a crucial role in treatment and patient safety.

For the purpose of this narrative review, we performed a detailed search of medical databases and selected studies describing the use of these drugs in patients during pregnancy, delivery and the pospartum period.

Uterotonics, above all oxytocin, play an important role in the prevention and treatment of pospartum haemorrhage, and various studies have shown that in obstetric procedures, such as scheduled and emergency caesarean section, they are effective at lower doses than those hitherto accepted. We also discuss the use of carbetocin as an effective alternative that has a therapeutic advantage in certain clinical circumstances.

Magnesium sulphate is the gold standard in the prevention and treatment of eclampsia, and also plays a neuroprotective role in preterm infants. We describe the precautions to be taken during magnesium administration.

Finally, we discuss the importance of understanding microbiology and the pharmacology of antibiotics in the management of obstetric infection and endometritis, and draw attention to the latest trends in antibiotic regimens in labour and caesarean section.

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