双胎妊娠合并Stanford A型主动脉夹层患者麻醉管理1例  

A case report of anesthesia management of twin pregnancy complicated with Stanford A type of aortic dissection

作　　者：陈超[1] 杨胜凤 王正刚 丁煌[1] 李梦云[1] 冯晓波[1] 郭唐曦 柯剑娟[1] Chen Chao;Yang Shengfeng;Wang Zhenggang;Ding Huang;Li Mengyun;Feng Xiaobo;Guo Tangxi;Ke Jianjuan(Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China;Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang 540004, China)

机构地区：[1]武汉大学中南医院麻醉科,430071 [2]贵州医科大学附属医院神经外科,贵阳540004

出　　处：《国际麻醉学与复苏杂志》2019年第6期554-558,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：妊娠合并主动脉夹层是妊娠期罕见的并发症,病情危重、母婴病死率高、麻醉管理难度大。报道1例双胎妊娠合并Stanford A型主动脉夹层患者同期行剖宫产和CPB开胸手术的麻醉和手术经过,为此类患者的麻醉管理提供参考。对于此类患者,术前需充分镇痛并适当控制血压,麻醉诱导力求平稳避免血压剧烈波动导致动脉瘤破裂。术中经食管超声心动图(transesophageal echocardiography, TEE)、BIS、脑局部血氧饱和度(regional cerebral oxygen saturation, SCO2)等监测可以很好地指导麻醉管理,加快患者术后康复。术后多学科合作治疗也是提高母儿生存率的重要手段。Pregnancy complicated with Stanford A aortic dissection is a rare complication during pregnancy, which is a severe condition with high mortality of maternal and infant. The anesthesia management in this case is difficult. This paper reports the anesthesia and surgical procedures of one case of twin pregnancy complicated with Stanford A aortic dissection to provide guidance for this kind of patient′s anesthesia management. Adequate analgesia and proper control of blood pressure should be performed on this type of patients before operation, and the anesthesia induction must be stable to avoid dissecting aneurysm rupture by rapid change of blood pressure. Intraoperative monitoring can guide the anesthesia management well and accelerate the postoperative rehabilitation such as transesophageal echocardiography (TEE), bispectral index of the electroencephalogram(BIS), regional cerebral oxygen saturation(SCO2) and so on. Multidisciplinary cooperative therapy is also an important means to improve the survival rate of mother and infant after surgery.

关 键 词：妊娠 主动脉夹层 麻醉 经食管超声心动图 

分 类 号：R614[医药卫生—麻醉学]