烟雾病伴蛛网膜下腔出血产妇行剖宫产术围手术期管理1例  

A case report about perioperative management in a pregnant woman with moyamoya disease and subarachnoid hemorrhage subjected to cesarean section

作　　者：李纯青[1] 曲元[1] Li Chunqing;Qu Yuan(Department of Anesthesiology, Peking University First Hospital, Beijing, 100034, China)

机构地区：[1]北京大学第一医院麻醉科,100034

出　　处：《国际麻醉学与复苏杂志》2018年第4期354-357,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：烟雾病合并蛛网膜下腔出血是一种威胁围生期孕妇生命的严重疾病状态。此类患者的围手术期麻醉管理对于母婴健康至关重要。报道1例烟雾病合并蛛网膜下腔出血产妇在全身麻醉下行剖宫产术。麻醉管理的基本原则是维持正常的脑血流量及脑灌注，同时避免颅内压及脑耗氧量的增加。手术期间在严密监测下，使用丙泊酚和瑞芬太尼进行镇静和麻醉，行机械通气维持呼吸功能稳定。CT检查示该产妇存在蛛网膜下腔出血，术后管理要点是预防脑血管痉挛、降低颅内压、控制SBP在正常范围。最后该产妇顺利出院，新生儿情况良好。总结该病例经验以期为此类产妇的麻醉管理提供参考。Moyamoya disease complicated with subarachnoid hemorrhage is a life-threatening condition in perinatal women. Perioperative anesthetic management of patients with this condition is critical to the health of mothers and neonates. Here we reported a case of this kind. The patient received cesarean section under general anesthesia. The general principle of anesthetic management of this patient is to maintain normal cerebral blood flow and cerebral perfusion while avoiding of the increase of intracranial pressure and cerebral oxygen consumption. During operation under intensive multi-indicator monitoring, we used propofol and remifentanil for sedation and anesthesia, and applied mechanical ventilation for maintenance of respiration. This case showed subaraehnoid hemorrhage, the efforts were made to prevent spasm of cerebral vaseulature, to reduce intraeranial pressure, and to control systolic blood pressure in normal range after operation. The patient eventually recovered, and was discharged with a healthy neonate from hospital. We provided detailed information about the comprehensive treatment for the reference in the field.

关 键 词：烟雾病 蛛网膜下腔出血 剖宫产术 麻醉 

分 类 号：R614[医药卫生—麻醉学]