5分钟即刻剖腹产细则.pdf

NPLD-GHI: Advanced Obstetric Anesthesia (AOA) 1-2-3 Plan （2-1） 附录 APPX2-1: 多学科即刻剖宫产演习细则 Multidisciplinary Crash Cesarean Delivery Simulation Drill Objectives 目的: Understand the impact of crash cesarean delivery on maternal and fetal safety, maximize the resource process by utilization of simulation drills, be able to deliver baby within 4-5 minutes from the time of decision to delivery: either by 1) transferring parturients to operating room or 2) bringing necessary equipment to the bedside. Drill nursing, anesthesia, and obstetrics teams in the maneuvers and in the patient safety concepts until they are confident and stress-free handling these situations. 充分理解即刻剖宫产对母婴安全的意义及必要性，因地制宜地采用就地或运送产妇的方法，在团队协作下，演练并实现通过剖宫产 5 分钟内（从临床决 定到小孩娩出） 基本功，满足临床的需要。也是对前面几天工作的全面检验。 Manpower 人员:  Obstetrician 产科医生  Anesthesiologist 麻醉科医生  Nurse 产房护士  Neonatologist 新生儿科医生 Settings 手术环境:  LDR to OR 产房去手术室（经典）  To Bedside 产床边（备选） Scenarios 临床情形  Cord prolapse 脐带脱垂  TOLAC with uterine rupture 二试中的子宫破裂 Assessment 评定  Video Capture 全程录像  Assessment Sheet 打勾评分 1 NPLD-GHI: Advanced Obstetric Anesthesia (AOA) 1-2-3 Plan （2-1） Maternal Physiologic Issues 母亲孕产期生理变化  Supine Hypotension Syndrome – compression of aorta and vena cava by gravid uterus 仰卧位低血压综合症－怀孕子宫压迫主动脉和腔 静脉  Quicker Rate of Desaturation – decreased FRC, higher O2 Consumption 血氧饱和度快速下降－减少功能残气量，增加氧耗  Potentially Difficult Intubation – airway edema, vascular engorgement, enlarged breasts 潜在性的困难气道－气道水肿、血管扩张、乳 房增大  Higher Risk of Aspiration – stomach displacement, decreased gastric emptying (from opioids and pain), rel