晚期妊娠合并严重心脏瓣膜病的综合治疗  

Combined therapy for patients with late pregnancy accompanied with severe valvular heart disease

作　　者：郭宏伟[1] 单忠贵[1] 周小彪[1] 姜金娜[2] 赖轶权[1] 匡锋[1] GUO Hongwei;SHAN Zhonggui;ZHOU Xiaobiao;JIANG Jinna;LAI Yiquan;KUANG Feng(Department of Cardiac Surgery,the First Affiliated Hospital of Xiamen University,Xiamen 361002,Fujian,China;不详)

机构地区：[1]厦门大学附属第一医院心脏外科,福建厦门361002 [2]厦门大学附属第一医院妇产科

出　　处：《上海医学》2019年第12期754-757,共4页Shanghai Medical Journal

摘　　要：目的探讨晚期妊娠合并严重心脏瓣膜病患者围产期综合治疗方法及其临床效果。方法回顾性分析2007年12月-2017年12月间在厦门大学附属第一医院心脏外科与妇产科联合治疗的32例晚期妊娠合并心脏瓣膜重度狭窄和(或)关闭不全患者的临床资料,对其产前治疗、围产期抗凝策略、麻醉和分娩方式选择、围产期并发症等进行总结分析。结果 32例患者均在有体外循环的条件下,于全身麻醉下行剖宫产结束妊娠。其中,按术前计划行剖宫产同期心脏手术患者11例;2例患者分别于麻醉过程中和娩出胎儿挤压子宫时出现心室颤动,遂紧急开胸于体外循环下继续完成剖宫产术,同期行心脏手术;1例重度二尖瓣狭窄患者剖宫产术后早期出现急性左侧心力衰竭、肺水肿,积极药物治疗效果不理想,紧急返回手术室行心脏瓣膜置换+三尖瓣成形术;18例患者单纯行剖宫产术,顺利度过围产期,另择期行心脏手术。无一例产妇死亡,母婴均,顺利恢复后出院。结论晚期妊娠合并严重心脏瓣膜病的患者应在全身麻醉、体外循环准备下选择剖宫产做为结束妊娠的方式。并由产科、心脏外科、麻醉科等经验丰富的专家共同协作,根据孕妇心脏基础疾病、心功能状态、胎儿状况等决定分娩时机,以及是否同期行心脏手术。Objective To explore the clinical outcomes of combined therapy for the patients with late pregnancy accompanied with severe valvular heart disease. Methods A total of 32 patients with late pregnancy accompanied with severe valvular heart disease(stenosis or regurgitation),who were admitted to our hospital between December 2007 and December 2017 and treated by combined therapy in the department of cardiac surgery and obstetrics, were enrolled in this retrospective study. Prenatal therapy, anticoagulation strategy of perinatal stage, anesthesia methods,delivery methods and perinatal complications were investigated. Results All the 32 patients received cesarean delivery under general anesthesia and the protection of cardiopulmonary bypass. Eleven patients received scheduled cesarean delivery and cardiac surgery simultaneously.Two patients received emergency cardiac surgery during cesarean delivery due to ventricular fibrillation. One patient with severe mitral valve stenosis was sent back to the operating room after cesarean delivery because of acute left heart failure, and received emergency mitral valve replacement and tricuspid valve valvuloplasty. Eighteen patients received cesarean delivery followed by elective cardiac surgery.There was no death during perinatal stage. All the 32 patients recovered well. Conclusion For the patients with late pregnancy and severe valvular heart disease, cesarean delivery should be used as the first choice to end the pregnancy. The operation can be finished under general anesthesia and the protection of cardiopulmonary bypass by the cooperation of experienced doctors of obstetric surgery,cardiac surgery and anesthesia. The time of delivery and heart operation should be determined according to the heart disease, heart function and fetal condition.

关 键 词：心脏瓣膜疾病 剖宫产术 体外循环 晚期妊娠 

分 类 号：R714.252[医药卫生—妇产科学]