摘要
目的:分析孕产妇行心血管手术的麻醉管理。方法:回顾性分析我院9例孕产妇行心血管手术的麻醉资料。平均年龄(28.3±4.7)岁,妊娠8w至产后2d,术中行二尖瓣手术2例,二尖瓣+主动脉瓣置换+冠状动脉旁路移植术1例,主动脉瓣手术1例,黏液瘤切除术3例,Bentall+主动脉弓置换术2例。3例先行剖宫产的患者采用小剂量氯胺酮或雷米芬太尼麻醉诱导,待胎儿娩出后再使用芬太尼或舒芬太尼加深麻醉外,另6例均采用芬太尼或舒芬太尼麻醉诱导。心血管手术中采用芬太尼或舒芬太尼为主的静吸复合麻醉,其中芬太尼平均用量(50±0.5)μg/kg,舒芬太尼平均用量(5.3±2.0)μg/kg。1例孕妇心脏复跳后因心功能低下采用体外膜肺(ECMO)辅助后脱机。结果:孕产妇术后顺利康复6例,死亡3例,术后病死率为33.3%,死亡原因为低心排血综合征、肺部感染与肾功能衰竭,其中3例行血液透析治疗,1例行ECMO及主动脉内球囊反搏(IABP)辅助治疗。术后新生儿健康成活5例,家属放弃抢救胎儿2例,人工流产2例,胎儿丢失率为44.4%。结论:孕产妇实施心血管手术的危险性较高,加强围术期麻醉管理,选择恰当的手术时机与手术方式,采取多学科合作的综合处理,有利于母婴顺利度过围术期。
Objective：To analyze the anesthetic methods and management for the pregnant and parturi- ent women undergoing cardiovascular surgery. Methods： The data of 9 women who underwent cardiovascular surgery was studied retrospectively. The age were （ 28. 3 ±4. 7 ） years, gestation age was from 8 weeks of gesta- tion to ：2 days after delivery. Preoperative concomitant diseases contained congestive heart failure （ n = 2） , se- vere pulmonary hypertension（ n = 1 ） , acute cerebral infarction（ n = 2 ） and left eye blindness （ n = 1 ）. Cardio- vascular interventions included mitral valvular replacement（ n = 1 ）, mitral valvuloplasty（ n = 1 ）, combined mi- tral and aortic valvular replacement ＋ coronary artery bypass grafting（ n = 1 ）, subaortic valvular diaphragm re- section（ n = 1 ）, atrial myxoma removal （ n = 3 ） and bentall ＋ total arch replacement ＋ stented elephant trunk implantation （n = 2）. All patients received balanced general anesthesia with fentanyl or sufentanil as the main anesthetics, but the anesthetic induction was different according to whether the women had performed cesarean section just before the cardiovascular operation or not. The induction drugs for 3 women undergoing cesarean section were low dose ketamine and/or remifentanil, while the other 6 patients were induced with fentanyl or sufentanil in routine doses for heart surgery, the total doses of fentanyl or sufentanil were （50. 5± 0. 5） μg/kg or （5.3 ± 2. 0） μg/kg respectively. Two patients received artificial abortion under basal anesthesia with propofol and small doses of fentanyl postoperatively. One patient with hypercholesterolemia received ECMO to wean from the cardiopulmonary bypass because of low cardiac output syndrome. Results： Of the 9 patients, 3 women diedpostoperatively, the maternal mortality rate was 33.3%. Five neonate survived, 2 fetus were abandoned by their families and 2 fetus were aborted postoperatively, the fetal loss rate was 44. 4%. Conclusion：The risk for pregnant and parturient women undergoing cardiovascular surgery is still high. It is necessary to understand the pathophysiological effects of pregnancy on cardiovascular diseases thoroughly, and to select appropriate opera- tion timing and procedure and take muhidisciplinary approach, so as to guarantee the maternal and fetal safety perioperatively.
出处
《心肺血管病杂志》
2013年第6期761-763,共3页
Journal of Cardiovascular and Pulmonary Diseases
关键词
孕产妇
心血管手术
麻醉
Pregnancy
Parturient
Cardiovascular surgery
Anesthesia
