妊娠期体外循环下心脏手术6例临床分析  

Clinical analysis of 6 patients with cardiac surgery under cardiopulmonary bypass during pregnancy

作　　者：陆利冲[1] 葛敏[1] 王东进[1] 

机构地区：[1]南京大学医学院附属鼓楼医院心胸外科,南京210008

出　　处：《临床外科杂志》2017年第5期356-359,共4页Journal of Clinical Surgery

基　　金：江苏省医学重点学科资助项目

摘　　要：目的探讨妊娠中晚期行体外循环下心脏手术的临床特点及手术对妊娠结局的影响。方法妊娠合并心脏病患者妊娠期行体外循环下心脏手术6例,术中采用搏动性、浅低温或常温灌注,预充液中加入黄体酮20 mg,监测子宫收缩情况及胎心率变化。二尖瓣置换+三尖瓣成形术3例,主动脉瓣置换+二尖瓣置换+三尖瓣成形术1例,左室黏液瘤切除术1例,左室流出道疏通术+人工主动脉瓣赘生物清除术+三尖瓣成形术1例。结果体外循环96~419分钟,平均169分钟;主动脉阻断56~296分钟,平均113分钟。1例术后6小时因心功能衰竭、肺水肿母体及胎儿死亡,其余5例母体均存活。其中1例术后因左心功能不全,术后第3天胎膜早破致胎死宫内,行剖腹取胎手术后顺利康复出院。2例患者因考虑药物对胎儿的影响在康复出院后选择了引产。2例患者继续妊娠至足月生产,1例顺产,1例剖宫产,新生儿均无异常。结论娠期体外循环下心脏手术是可行的,可有效降低妊娠合并心脏病妇女的母婴死亡率。Objective To evaluate the optimal management of cardiac surgery during pregnancy,in the second or third trimester,and the maternal and fetal outcomes in pregnant patients after surgery.Methods Six pregnant women with heart diseases were identified,who underwent cardiac surgery with cardiopulmonary bypass.Surgery was performed using cardiopulmonary bypass at mild hypothermia/normothermia,with pulsatile perfusion.Natural progesterone（20 mg）was added in priming solution,monitoring uterine contractions and heart rate changes.The mode of surgeries included mitral valve replacement＋tricuspid valve plastic in three cases,aortic and mitral valve replacement＋tricuspid valve plastic in one,left ventricular myxomatomy in one,left ventricular septal myectomy＋artificial aortic valvular vegetations dissection＋tricuspid valve plastic in one.Results The cardiopulmonary bypass and cross clamp time averaged 169 minutes（range,96~419 minutes）and 113 minutes（range,56~296 minutes）,respectively.Five patients were alive.One maternal and fetal death occurred 6 h after surgery caused by heart failure and pulmonary edema.The other 5 patients terminated pregnancies after heart surgeries,one underwent with cesarean section 3 d after surgery in second trimester,two of whom with induction of labor,and two full-term labor（one with cesarean section,one with normal delivery）.Two newborns were alive with no malformation.Conclusion Cardiopulmonary bypass can be used safely with satisfactory maternal and fetal outcomes in pregnant patients with heart disease undergoing cardiac surgery.

关 键 词：心脏外科 体外循环 妊娠结局 

分 类 号：R714.252[医药卫生—妇产科学]