Publication in refereed journal
香港中文大学研究人员 ( 现职)
| Professor Warwick Dean NGAN KEE (麻醉及深切治疗学系) |
| 许金山教授 (麻醉及深切治疗学系) |
全文
| 数位物件识别号 (DOI) http://dx.doi.org/10.1097/01.aco.0000137089.37484.5e |
引用次数
Scopushttp://aims.cuhk.edu.hk/converis/portal/Publication/15Scopus source URL
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摘要Purpose of review: This review summarises the current issues, knowledge and research on the effects of maternal supplementary oxygen therapy on the fetus during Caesarean section. This is a controversial subject since supplementary oxygen has the potential to confer both benefits and also harm to the fetus, depending on the circumstances. Recent findings: For elective Caesarean section, breathing room air under regional anaesthesia or 30% oxygen under general anaesthesia is not associated with either maternal or fetal hypoxia. A prolonged uterine-incision-to-delivery (U-D) interval of up to 310 s is not a major factor per se for development of fetal hypoxia or acidosis, and no benefits could be derived from breathing supplementary oxygen in this situation. Although it appears rational to provide supplementary oxygen in the presence of a hypoxic or compromised fetus, to achieve meaningful increases in fetal oxygenation, a very high inspired oxygen fraction (FiO2) is required. However, it still remains unclear whether this is beneficial for the fetus. The process of damage to the hypoxic fetus is one of oxidative stress mediated by free radicals generated during reperfusion (ischaemia-reperfusion injury). Independently, hyperoxia from breathing supplementary oxygen also induces formation of free radicals by direct mitochondrial electron transfer. Although hyperoxia could lessen the severity of fetal hypoxia, there is also a theoretical risk of an enhanced reperfusion injury. This issue has not been resolved in a clinical study, but an animal study reported enhanced formation of free radicals after an episode of fetal hypoxia in the group receiving supplementary oxygen. Summary: For elective Caesarean section, current evidence suggests that supplementary oxygen is unnecessary. For emergency Caesarean section, further data are required before a conclusion can be made for its beneficial and adverse effects. Improvement of fetal oxygenation should be the primary objective, and this is achievable in the short term by using a very high FiO2. Although there is also a possibility of an enhanced reperfusion injury, particularly in the preterm and non-labouring patients, further data are necessary before a conclusion can be made. ? 2004 Lippincott Williams & Wilkins.
着者Khaw K.S., Ngan Kee W.D.
期刊名称Current Opinion in Anaesthesiology
出版年份2004
月份8
日期1
卷号17
期次4
出版社Lippincott Williams & Wilkins Ltd.
出版地United States
页次309 - 313
国际标準期刊号0952-7907
电子国际标準期刊号1473-6500
语言英式英语
关键词Anaesthesia, Caesarean section, Fetal distress, Fetus, Free radical, Maternal, Oxygen
