妊娠合并肺动脉高压产妇的围术期麻醉管理  

Perioperative anesthesia management for pregnant patients with pulmonary arterial hypertension

作　　者：熊亚 文静 何青盈 顾建腾 易斌 鲁开智 甯交琳 XIONG Ya;WEN Jing;HE Qingying;GU Jianteng;YI Bin;LU Kaizhi;NING Jiaolin(Department of Anesthesiology,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院麻醉科,重庆400038

出　　处：《陆军军医大学学报》2023年第13期1422-1429,共8页Journal of Army Medical University

摘　　要：目的探讨和总结妊娠合并肺动脉高压产妇剖宫产术中围术期麻醉管理的方法经验。方法选择2015年2月17日至2022年5月19日于陆军军医大学第一附属医院行剖宫产的妊娠合并肺动脉高压(pulmonary arterial hypertension,PAH)产妇为研究对象,对临床资料进行回顾性病例对照研究,分析和总结围术期麻醉管理的要点。结果术前完善45例妊娠合并肺动脉高压行剖宫产术的产妇的各项检查,多学科协作诊疗,确定最佳的分娩时机。术中予以科学的麻醉监测管理,合理有效地应用血管活性药物和补充血容量以维持产妇术中生命体征平稳。1例因术中发生肺动脉高压危象导致心功能和呼吸功能衰竭死亡,余下44例(97.8%)产妇均安全完成剖宫产手术,其中33例(73.3%)返回产科普通病房,其余11例(24.4%)术后转入ICU进一步治疗,其中1例重度肺动脉高压产妇在ICU治疗过程中因心源性休克而死亡。PAH危险分级越高的产妇,不良结局和对胎儿的不良影响发生率也越高。结论在多学科诊疗协作和全面术前评估和准备的基础上,联合科学有效的麻醉监测和处理,尤其重视中重度PAH产妇的管理和监测,是改善妊娠合并PAH产妇剖宫产预后,提高安全性的麻醉管理策略。Objective To explore and summarize our experience of perioperative anesthesia management for pregnant patients with pulmonary arterial hypertension(PAH)undergoing cesarean section.Methods A retrospective case-control trial was performed on 45 pregnant patients with PAH who underwent cesarean section in our hospital from February 17,2015 to May 19,2022.The perioperative anesthesia management were analyzed and summarized.Results These 45 PAH pregnant patients who underwent cesarean section completed all related examinations before operation,and the best time for delivery was determined through multidisciplinary collaborative diagnosis and treatment.Scientific anesthesia monitoring and management were carried out during the operation,and vasoactive drugs and blood volume supplementation were applied reasonably and effectively to maintain the stable vital signs during the operation.Only 1 case died of cardiac and respiratory failure due to pulmonary hypertension crisis intraoperatively,and the remaining 44 cases(97.8%)completed cesarean section safely.Among them,33 cases(73.3%)returned to the obstetric ward,and the other 11(24.4%)were transferred to ICU for further treatment after operation.One of them with severe PAH died after being transferred to ICU due to cardiogenic shock.The higher risk grade of PAH,the incidence of adverse outcomes and adverse effects on the fetus were higher.Conclusion On the basis of multidisciplinary collaborative diagnosis and treatment and adequate preoperative assessment and preparation,combination of scientific and effective anesthesia management and especially,focusing on the puerpera with severe PAH is an important strategy for perioperative anesthesia management of pregnant PAH patients during cesarean section.

关 键 词：妊娠 肺动脉高压 围术期 麻醉管理 

分 类 号：R614[医药卫生—麻醉学] R619[医药卫生—外科学] R714.252[医药卫生—临床医学]