Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990
Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990
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DOI：
10.1097/00000542-199702000-00002
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发表时间：
1997-02-01
期刊：
影响因子：
8.8
通讯作者：
Gibbs, CP
中科院分区：
文献类型：
--
作者：
Hawkins, JL;Koonin, LM;Gibbs, CP
麻醉相关并发症是美国妊娠相关死亡的第六大原因。本研究报告了1979- 1990年美国产科分娩麻醉相关死亡的特征。方法：各州向疾病控制和预防中心报告分娩后1年内的死亡，作为正在进行的妊娠死亡率监测的一部分。回顾了1979-1990年与活产或胎儿死亡证明相匹配的孕产妇死亡证明（已删除标识符），以确定麻醉导致的死亡、死亡原因、分娩程序和提供的麻醉类型。计算每百万活产的产妇死亡率，计算病死率和风险比，以比较剖宫产分娩的全身麻醉和区域麻醉。与麻醉有关的孕产妇死亡率从前三年的每百万活产4.3人下降到2005年的每百万活产4.3人1979-1981年的死亡率为1.7%.，1988-1990年的死亡率为1.7%.，与全身麻醉有关的死亡人数保持稳定，但与区域麻醉有关的死亡人数自1984年以来有所下降。1985年以前全麻的病死率是区域麻醉的2.3倍（95%CI，1.9-2.9），1985年以后增加到16.7倍（95%CI，12.9-21.8）。结论：麻醉并发症导致的孕产妇死亡多发生在全麻剖宫产术中。局部麻醉并非没有风险，主要是因为局部麻醉剂的毒性和过高的局部阻滞。然而，这些死亡的发生率正在下降，全身麻醉导致的死亡人数保持稳定，因此占总死亡人数的比例增加，对局部麻醉剂毒性的认识提高和技术的相关改进可能有助于减少局部麻醉并发症。
Background Anesthesia-related complications are the sixth leading cause of pregnancy-related death in the United States. This study reports characteristics of anesthesia-related deaths during obstetric delivery in the United States from 1979-1990.Methods: Each state reports deaths that occur within 1 yr of delivery to the Centers for Disease Control and Prevention as part of the ongoing Pregnancy Mortality Surveillance. Maternal death certificates (with identifiers removed) matched with live birth or fetal death certificates when available from 1979-1990 were reviewed to identify deaths due to anesthesia, the cause of death, the procedure for delivery, and the type of anesthesia provided. Maternal mortality rates per million live births were calculated, Case fatality rates and risk ratios were computed to compare general to regional anesthesia for cesarean section deliveries.Results: The anesthesia-related maternal mortality rate decreased from 4.3 per million live births in the first triennium (1979-1981) to 1.7 per million in the last (1988-1990), The number of deaths involving general anesthesia have remained stable, but the number of regional anesthesia-related deaths have decreased since 1984. The case-fatality risk ratio for general anesthesia was 2.3 (95% confidence interval [CI], 1.9-2.9) times that for regional anesthesia before 1985, increasing to 16.7 (95% CI, 12.9-21.8) times that after 1985.Conclusions: Most maternal deaths due to complications of anesthesia occurred during general anesthesia for cesarean section. Regional anesthesia is not without risk, primarily because of the toxicity of local anesthetics and excessively high regional blocks. The incidence of these deaths is decreasing, however, and deaths due to general anesthesia remain stable in number and hence account for an increased proportion of total deaths, Heightened awareness of the toxicity of local anesthetics and related improvements in technique may have contributed to a reduction in complications of regional anesthesia.