產後出血之麻醉照護

The Anesthetic Management of Postpartum Hemorrhage

產後出血（postpartum hemorrhage）是全世界孕產婦死亡的主要原因，可能是原發性或繼發性，一種常見且可能危及生命的產科併發症，成功的治療在很大程度上依賴於出血的早期發現和及時正確處置治療。預期的產後出血必須針對胎盤異常、遺傳性凝血障礙等，合併宮縮劑使用能降低嚴重出血風險，及準備複合式手術室血管攝影功能的手術房，而非預期緊急產後出血時需合併多科，如：婦產科、麻醉科、手術室團隊、實驗室血液人員、放射科進行動脈栓塞術等團隊，共同參與溝通醫治，在麻醉前準備因應妊娠生理、心理、疾病影響以考慮麻醉方式。研究指出陰道分娩中，若未接受麻醉與半身麻醉，在24小時內的產後出血不受影響，但接受全身麻醉，其發生產後出血的發生率比接受半身麻醉高出8.15倍，因此，產後出血之麻醉照護應監控失血量臨床徵象、輸血輸液、電解質及酸鹼值等以達到身體平衡狀態，必要時置放氣管內管，並評估術後移除的風險、觀察輸血相關急性肺損傷或循環超負荷等症狀發生，需要時轉送至加護病房監護。

Postpartum hemorrhage, classified as either primary or secondary, is a leading cause of maternal mortality worldwide and a common and potentially life-threatening obstetric complication. Successful management of this condition is largely dependent on early detection and timely, appropriate intervention. In assessing the risk of postpartum hemorrhage, factors such as placental abnormalities and hereditary coagulopathies must be considered. The administration of uterotonic agents may reduce the risk of severe hemorrhage, and surgical facilities should be equipped with hybrid operating rooms with angiographic capabilities. In cases of unexpected emergency postpartum hemorrhage, a multidisciplinary approach is essential, involving obstetricians, anesthesiologists, surgical teams, laboratory hematology staff, and interventional radiologists able to perform procedures such as arterial embolization. Effective communication and coordination within these teams are crucial for optimal patient outcomes. Pre-anesthetic preparation should take into account physiological, psychological, and pathological changes associated with pregnancy. The results of related studies indicate that postpartum hemorrhage within 24 hours is not significantly affected by the use of neuraxial anesthesia during vaginal delivery. However, general anesthesia has been shown to increase the risk of postpartum hemorrhage by 8.15 times compared to when regional anesthesia is used. The close monitoring of blood loss, clinical signs, fluid and blood transfusions, electrolyte balance, and acid-base status is essential to maintaining hemodynamic stability. Endotracheal intubation may be necessary, with postoperative extubation risks carefully assessed. Furthermore, clinicians should monitor for complications such as transfusion-related acute lung injury or circulatory overload. In severe cases, patients should be transferred to the intensive care unit for further management.