围产期心肌病合并急性心力衰竭剖宫产麻醉处理1例  

Anesthesia for caesarean section in a gravida with peripartum cardiomyopathy combined with acute heart failure: a case report

作　　者：曾鸿[1] 李晓曦[1] 赵文秋[2] 冯新恒[3] 郭向阳[1] 

机构地区：[1]北京大学第三医院麻醉科,北京100191 [2]北京大学第三医院妇产科,北京100191 [3]北京大学第三医院心内科,北京100191

出　　处：《北京大学学报（医学版）》2012年第5期804-807,共4页Journal of Peking University:Health Sciences

摘　　要：围产期心肌病（peripartum cardiomyopathy,PPCM）指既往无心血管系统疾病史,于妊娠最后3个月或产后6个月内发生的扩张型心肌病。严重的围产期心肌病常常表现为失代偿性充血性心力衰竭,对母婴危害极大。本文报道1例围产期心肌病合并急性心力衰竭患者行剖宫产手术抢救成功。1临床资料患者女,18岁,体重65 kg,主诉：＂停经41＋4周,Peripartum cardiomyopathy（PPCM） is a rare but serious form of cardiac failure affecting women in the last month of pregnancy or early puerperium within six months.Clinical presentation of PPCM is similar to that of idiopathic dilated cardiomyopathy,and maternal mortality is high.An 18 year-old primigravida was admitted to our hospital at the end of forty-one weeks of gestation.She was diagnosed with PPCM complicated with heart failure.Preoperative optimization was done with a view to managing left ventricular failure.Continuous epidural anesthesia in the sitting position with lidocaine was used for cesarean section.The baby was delivered successfully.Intravenous furosemide 20 mg,morphine 10 mg,cedilanid 0.4 mg were given.Nitroglycerin and milinone infusions continued throughout the surgery titrated to the hemodynamics.The patient received inotropic agents,dieresis,vasodilators and anticoagulants postoperatively.Both the mother and the baby were discharged safely 9 days after operation.

关 键 词：围产期 心肌疾病 心力衰竭 剖宫产术 麻醉 

分 类 号：R719.8[医药卫生—妇产科学]