超声心动图评估妊娠合并严重心脏病患者剖宫产围术期心容量及功能的变化特征  

Evaluation of perioperative cardiac volume and function by echocardiography in pregnant patients with severe heart disease during caesarean section:14 cases analysis

作　　者：江岚[1] 梁伟翔[1] 苏春宏[2] 苏志源[3] 刘丹丹[1] 戴丽 陈敦金[2] Jiang Lan;Liang Weixiang;Su Chunhong;Su Zhiyuan;Liu Dandan;Dai Li;ChenDunjin(Department of Medical Ultrasound,The Third Affiliated Hospital of Guangzhou Medical University,Key Laboratory of Obstetrics Major Diseases of Guangdong Province,Guangzhou Medical Center for Critical Pregnant Women,Guangzhou 510150,China;Department of Obstetrics and Gynecology,The Third Affiliated Hospital of Guangzhou Medical University,Key Laboratory of Obstetrics Major Diseases of Guangdong Province,Guangzhou Medical Center for Critical Pregnant Women,Guangzhou 510150,China;Department of Anesthesia,The Third Affiliated Hospital of Guangzhou Medical University,Key Laboratory of Obstetrics Major Diseases of Guangdong Province,Guangzhou Medical Center for Critical Pregnant Women,Guangzhou 510150,China)

机构地区：[1]广州医科大学附属第三医院、广州重症孕产妇救治中心、广东省产科重大疾病重点实验室超声医学科,510015 [2]广州医科大学附属第三医院、广州重症孕产妇救治中心、广东省产科重大疾病重点实验室妇产科,510015 [3]广州医科大学附属第三医院、广州重症孕产妇救治中心、广东省产科重大疾病重点实验室麻醉科,510015

出　　处：《中华产科急救电子杂志》2023年第1期28-35,共8页Chinese Journal of Obstetric Emergency（Electronic Edition）

基　　金：广州市科技计划项目资助(202201020167)。

摘　　要：目的探索妊娠合并严重心脏病患者剖宫产围术期的心容量及功能的连续性变化特征。方法选取2019年4月至2021年4月在广州医科大学附属第三医院进行剖宫产的妊娠合并严重心脏病并具有Ⅳ级心血管风险的患者进行前瞻性观察,采用超声心动图于剖宫产术前30 min内、手术开始时、取胎后、取胎盘后、静滴催产素、关腹后及产后7 d内连续性评估患者的心容量及心功能,并同时分析患者临床资料。结果共纳入患者14例,特发性肺高压4例,风湿性心脏病3例,扩张型心肌病2例,围产期心肌病1例,非梗阻性肥厚型心肌病1例,先天性心脏病1例,感染性心内膜炎1例,斯蒂尔病累及心脏病变1例。LAESV、LAEDV、LVEDV、LVESV、LHEDV在手术开始时、取胎后及取胎盘后容量下降,静滴催产素时容量逐渐回升并在关腹后超过术前水平,LHEDV波幅范围在-21.5%~5.44%,最大波幅位于取胎盘后;RAESV、RAEDV、RVEDV、RVESV、RHEDV在手术开始时容量上升,随后在取胎后、取胎盘后、静滴催产素阶段逐渐下降并接近术前水平,关腹后下降至最低随后逐渐回升但低于术前水平RHEDV波幅范围内在-15.51%~12.11%,最大波幅位于关腹后;LAFAC、LVEF、MAPSE、LVGCPS均在静滴催产素后下降,LVGLPS在静滴催产素后上升随后下降,RAFAC、RVFAC、TAPSE、RVGLPS均在静滴催产素后上升;但围术期各阶段容量及功能指标差异无统计学意义(P>0.05)。结论妊娠合并严重心脏病患者剖宫产围术期的心容量及功能变化具有一定的规律可循,左心容量在手术开始后至关腹前均明显下降,右心容量在手术开始时和关腹后波幅较大,是剖宫产术中重点监测阶段。由于本研究的影响因素较多,围手术期各阶段的差异未能获得统计学意义,但为下一步的相关研究提供了一定的参考价值。Objective To explore the changes in cardiac volume and function in pregnant women with severe heart disease during perioperative period of cesarean section.Methods According to the inclusion and exclusion criteria,pregnant patients with severe disease who underwent cesarean section in the Third Affiliated Hospital of Guangzhou Medical University were selected for prospective observation.The cardiac volume and function of the patients were assessed within 30 minutes before cesarean section,at the beginning of cesarean section,after fetal extraction,after placenta extraction,after oxytocin infusion,after abdominal closure,and within 7 days postpartum,and clinical data of the patients were collected.Results A total of 14 patients were included,including 4 cases of idiopathic pulmonary hypertension,3 cases of rheumatic heart disease,2 cases of dilated cardiomyopathy,1 case of perinatal cardiomyopathy,1 case of hypertrophic cardiomyopathy,1 case of congenital heart disease,1 case of infective endocarditis,and 1 case of Steele′s disease involving cardiac disease.The LAESV,LAEDV,LVEDV,LVESV and LHEDV decreased at the beginning of surgery,after fetal and placenta retrieval.The LHEDV gradually increased during intravenous oxytocin infusion and exceeded the preoperative level after abdominal closure.The LHEDV amplitude ranged from-21.5%to 5.44%,and the maximum amplitude was after placenta retrieval.The RAESV,RAEDV,RVEDV,RVESV and RHEDV increased at the beginning of surgery,and then gradually decreased to the preoperative level after fetal retrieval,placenta retrieval and oxytocin infusion,and then decreased to the lowest level after abdominal closure and gradually increased but was lower than the preoperative level.The RHEDV amplitude range was-15.51%-12.11%,the maximum amplitude was after abdominal closure.The LAFAC,LVEF,MAPSE and LVGCPS decreased after intravenous oxytocin,LVGLPS increased and then decreased after intravenous oxytocin,and RAFAC,RVFAC,TAPSE and RVGLPS increased after intravenous oxytocin.However,those m

关 键 词：妊娠 心脏病 剖宫产术 心脏容量 超声心动描记术 多普勒 

分 类 号：R540.45[医药卫生—心血管疾病] R719.8[医药卫生—内科学]