妊娠期行心内直视手术的体外循环管理策略  

Strategy and management of cardiopulmonary bypass with cardiac surgery for pregnant women

作　　者：陈祥舟[1] 肖颖彬[1] 郝嘉[1] 文仁国[1] 刘梅[1] 

机构地区：[1]第三军医大学新桥医院全军心血管外科研究所体外循环组,重庆400037

出　　处：《局解手术学杂志》2017年第12期893-896,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨妊娠期行心内直视手术的体外循环管理策略。方法回顾性分析2016年1月至2017年6月我院4例妊娠期合并严重心脏病行心内直视手术患者的体外循环临床资料及术后孕妇与胎儿的随访情况。结果 4例患者中感染性心内膜炎1例,先天性心脏病合并感染性心内膜炎2例,风湿性心脏病1例;按纽约心脏病协会(NYHA)心功能分级,Ⅲ级2例,Ⅳ级2例。手术为二尖瓣置换、三尖瓣成形2例,右冠状动脉右房瘘、主动脉瓣置换1例,动脉导管结扎加二尖瓣、主动脉瓣、肺动脉瓣置换、三尖瓣成形1例。体外循环时间85~287 min(中位数135 min),主动脉阻断时间52~178 min(中位数89 min),心脏手术时孕期25~32周(中位数29周)。术后随访1~16个月(中位数6个月);全组无孕妇死亡;足月剖腹产3例均存活,未发现畸形;1例胎死宫内,术后2 d自然流产。结论妊娠期行心脏手术是安全可行的,应针对孕期的生理特点,制定合理的体外循环计划,加强术中管理和监测,可有效提高孕妇和胎儿围术期存活率,减少并发症的发生。Objective To evaluate the strategy and management of cardiopulmonary bypass （CPB） with cardiac surgery for pregnant women. Methods The clinical data of 4 pregnant women with severe cardiac diseases,who received cardiac surgery with CPB in our hospital form January 2016 to June 2017 were retrospectively analyzed, meanwhile the maternal and neonatal outcomes were reviewed also. Results Among 4 patients, there were 1 case of subacute bacterial endocarditis ,2 cases of congenital heart disease complicated with subacute bacterial endocarditis, 1 case of rheumatic heart disease. The New York Heart Association （NYHA） functional classlfication：there were 2 cases with class l]I and 2 cases with class IV. Operations included 2 mitral valve replacement and tricuspid valve plasty, 1 fight coronary artery fistula re- pair and aortic valve replacement, 1 patent ductus arteriosus closure and mitral valve repalcement, aortic valve replacememnt, pulmonary valve replacement ,tricuspid valve plasty. The CPB time ranged from 85 to 287 minutes（ median 135 minutes）, the aortic cross clamp time ranged from 52 to 178 minutes （median 89 minutes） ,the gestational age of pateints received cardia surgery ranged from 25 to 32 weeks（ median 29 weeks）. All patients were followed up for 1 to 16months（ median 6 months） ,with no death;4 neonatal outcomes included 3 of full-term labor with cesarean section, all of the 3 newborns were alive and no malformation, 1 of death in the uterus and spontaneous abortion at 2 days post- operative. Conclusion Cardiac surgery can be performed with relative safety during pregnancy. According to the physiological characteristics of pregnancy, a reasonable CPB plan should be formulated pre-operative, better maternal and fetal survival rates may be achieved by optimized management of CPB and used fetal mornitoring perioperative, reduce the incidence of complications.

关 键 词：妊娠期 心脏病 心内直视手术 体外循环 

分 类 号：R541[医药卫生—心血管疾病] R714[医药卫生—内科学]