摘要
目的总结七氟醚、舒芬太尼和丙泊酚静吸复合全身麻醉应用于宫内胎儿心脏介入治疗(FCI)的临床经验。方法2018年7月至2019年3月青岛市妇女儿童医院采用FCI术治疗12例先天性心脏病胎儿。其中室间隔完整型肺动脉闭锁伴右心发育不良10例,室间隔完整型危重肺动脉瓣狭窄伴右心发育不良2例。所有孕妇通过七氟醚(0.75~1.0 MAC)、舒芬太尼(0.15μg/kg)和丙泊酚(2.0 mg/kg)静吸复合全身麻醉实现胎儿麻醉。总结孕妇和胎儿麻醉效果和并发症等临床情况。结果12例FCI术中胎儿体位固定良好,均成功完成手术。所有孕妇术中循环稳定,无心力衰竭、呼吸衰竭、喉损伤等麻醉并发症,无孕妇死亡。术中9例胎儿出现心动过缓,给予心内注射阿托品/肾上腺素恢复正常。术后当日3例孕妇出现恶心呕吐,对症治疗后均好转;1例出现轻度腹痛,无特殊处理自行好转。术后11例胎儿宫内随访未见明显异常,均随访至足月行剖宫产顺利分娩;1例胎儿出现心力衰竭,终止妊娠。结论七氟醚、舒芬太尼和丙泊酚静吸复合全身麻醉下孕妇和胎儿循环稳定,子宫松弛适度,胎儿体位固定良好,可保证FCI术顺利进行。该麻醉方法安全有效。
Objective To summarize the clinical experience of compound general anesthesia using sevoflurane, sufentanil and propofol in intrauterine fetal cardiac intervention(FCI). Methods Between July2018 and March 2019 at Qingdao Women and Children’s Hospital of China, FCI was carried out in 12 fetuses with congenital heart disease. The congenital heart diseases included pulmonary atresia associated with right heart dysplasia and complete interventricular septum(n=10), critical pulmonary valve stenosis associated with right heart dysplasia and complete interventricular septum(n =2). All 12 pregnant women received resting inhalation compound general anesthesia by using sevoflurane(0.75-1.0 MAC),sufentanil(0.15 μg/kg) and propofol(2.0 mg/kg) to obtain fetus anesthesia. The effects and complications of anesthesia in pregnant women and fetuses were summarized. Results Successful FCI was accomplished in all 12 pregnant women, and during the procedure the fetus was well fixed. The circulation of all pregnant women remained stable during operation. Neither anesthesia-related complications such as heart failure, respiratory failure, laryngeal injury,etc. nor death occurred. During operation 9 fetuses developed bradycardia, which returned to normal after intracardiac injection of atropine/adrenaline. After surgery, 3 pregnant women had nausea and vomiting, and the symptoms were improved after symptomatic treatment. One patient had mild abdominal pain, which was spontaneously improved without special management. After treatment, 11 intrauterine fetuses were followed up and no obvious abnormalities were observed until full-term delivery with caesarean section. One fetus developed heart failure and termination of pregnancy had to be carried out. Conclusion Under resting inhalation compound general anesthesia by using sevoflurane, sufentanil and propofol, the circulation status of both pregnant woman and fetus remains stable, the uterus is properly relaxed and the fetus is well fixed,all of which can ensure achieving a successful intrauterine FCI. Therefore, this anesthesia technique is safe and effective.
作者
王葵亮
王敦亮
罗刚
泮思林
WANG Kuiliang;WANG Dunliang;LUO Gang;PAN Silin(Heart Center,Qingdao Women and Childrens Hospital,Qingdao,Shandong Province 266034,China)
出处
《介入放射学杂志》
CSCD
北大核心
2021年第2期123-126,共4页
Journal of Interventional Radiology
基金
国家自然科学基金(81770316、81970249)
泰山学者工程资助项目(2018)。
关键词
胎儿
孕妇
先天性心脏病
心脏介入
全身麻醉
fetus
pregnant woman
congenital heart disease
cardiac intervention
general anesthesia
