摘要
目的先天性心脏病（先心病）合并重度肺动脉高压孕妇剖宫产麻醉的回顾性分析。方法先心病合并重度肺动脉高压、无心脏手术史孕妇8例，均选择椎管内麻醉下行剖宫产术。年龄19岁-38岁，体重55kg-74kg，妊娠35周～39周，平均肺动脉压（mean pulmonary arterial pressure，MPAP）55mmHg-75mmHg（ImmHg=0．133kPa）。其中室间隔缺损5例（1例为右心功能不全，心包腔积液、肝脏肿大），动脉导管未闭艾森曼格综合征l例，右室双出口2例。所有患者于麻醉前（T1）、麻醉后5min（T2）、胎儿娩出前（B）、胎儿娩出后（T4）、静脉滴注催产素10U后2min（B）和返回病房前（T6）时间点，记录、分析平均动脉压（mean arterial pressure，MAP）、脉搏血氧饱和度（pulse oxygen saturation，SpO2）、心率（heart rate，HR）以及中心静脉压（central venous pressure，CVP）等数据变化。结果①8例患者麻醉效果满意，新生儿健康，术中出现心动过缓、心功能衰竭等并发症经对症处理后均好转。②血流动力学变化显示，T4时间点MAP和SpO2分别为（60±7）mmHg和（90．8±2．0）％，与T3比较，分别下降了18％和6％（P〈0．05）；HR为（118±14）次／min，与T3比较，升高25％（P〈0．05）。T5时间点MAP和SpO2分别为（78±9）mmHg和（96．8±2．4）％，与T4比较，分别升高了23％和7％（P〈0．05）；HR为（91±11）次／min，与T4比较。减慢约24％（P〈0．05）。结论先心病合并重度肺动脉高压的剖宫产患者选择椎管内麻醉是可行的。
Objective Retrospective analysis for the patients of congenital heart disease with severe pulmonary hypertension undergoing cesarean section. Methods Eight cases of congenital heart disease with severe pulmonary hypertension, pregnant women without heart operation history, all choose spinal anesthesia for cesarean section. The age arranged from 19 y-38 y, the weight of 55 kg-74 kg, pregnancy 35 week-39 week, mean pulmonary arterial pressure （MPAP） 55 mmHg-75 mmHg （1 mmHg= 0.133 kPa）. Of which 5 cases of ventrieular septal defect （1 ease of right heart insufficiency, pericardial effusionand liver enlargement）, 1 case of patent duetus arteriosus with Eisenmenge＇s syndrome, 2 cases with double outlet right ventricle. The following time points were recorded, before anesthesia （T1）, 5 min after anesthesia （T2）, before the delivery of fetus （T3）, after the delivery of fetus （T4）, 2 min after intravenous drip of 10 U oxytocin （T5） and before returned to the wards （T6）. The data of mean arterial pressure （MAP）, pulse oxygen saturation （SpO2）, heart rate （HR） and central venous pressure （CVP） were recorded and analyzed. Results （1） Eight patients anesthesia effects were satisfied, neonates were healthy, intraoperative complications, such as heart failure, bradyeardia were improved after symptomatic treatment. （2） Hemodynamie changed as follows, at T4, MAP and SpO2 were（60±7 ） mmHg and （90.8±2.0）%, and the ratio decreased by 18% and 6% respectively compared to that of T3 （P〈0.05）. At the same time, HR （118±14 ） bpm increased, and the ratio increased of around 25% compared to that of T3 （P〈0.05）. At T5, MAP and SpO2 were（78±9） mmHg and （96.8-＋2.4）%, and the ratio increased by 23% and 7% respectively compared to that of T4 （P〈0.05）. At the same time, HR （91±11） bpm showed decreased, and the ratio slowed down to about 24% compared to that of T4 （P〈0.05）. Conclusions For congenital heart disease with severe pulmonary hypertension underwent cesarean section, choose spinal anesthesia is feasible.
出处
《国际麻醉学与复苏杂志》
CAS
2015年第12期1102-1105,共4页
International Journal of Anesthesiology and Resuscitation
基金
南京市医学科技发展重点项目（ZKX14025）
南京市医学科技发展项目（YKK13069）
关键词
妊娠
先天性心脏病
重度肺动脉高压
血流动力学
Pregnancy
Congenital heart disease
Severe pulmonary hypertension
Hemodynamics
