妊娠合并重度肺动脉高压病人剖宫产手术麻醉管理  

ANESTHETICMANAGEMENT DURING CESAREAN SECTION FOR PREGNANT PATIENTS WITH SEVERE PULMONARY HYPERTENSION

作　　者：柴东岳 吕琳[1] 刘孝洁[1] 高洁[1] 冯伟[1] CHAI Dongyue;L Lin;LIU Xiaojie;GAO Jie;FENG Wei(Department of Anesthesiology,Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院麻醉科,山东青岛266000

出　　处：《青岛大学学报(医学版)》2023年第5期684-686,共3页Journal of Qingdao University(Medical Sciences)

基　　金：国家自然科学基金项目(81902001)。

摘　　要：目的探讨妊娠合并重度肺动脉高压病人行剖宫产手术的麻醉管理要点。方法回顾性分析11例妊娠合并重度肺动脉高压病人行剖宫产手术的临床资料、麻醉管理和术后转归等。结果11例病人的肺动脉压力为10.640~23.009 kPa,平均(14.364±3.724)kPa;心功能分级Ⅱ级2例(18.2%),Ⅲ级2例(18.2%),Ⅳ级7例(63.6%);心功能Ⅲ和Ⅳ级共9例(81.8%)病人均在术前接受了多学科会诊及药物治疗。术中10例(90.9%)病人接受硬膜外麻醉,1例(9.1%)接受全身麻醉;术中均给予降低容量负荷、药物扩张肺动脉、预防肺动脉痉挛、降低肺动脉压等干预处理。11例病人术后均转入ICU,其中2例(18.2%)死于右心衰竭,其余9例(81.8%)顺利出院。1例(9.1%)新生儿因早产死亡,其余10例(90.9%)新生儿均存活。结论妊娠合并重度肺动脉高压病人心功能差,易诱发心力衰竭。围手术期应进行充分评估、合理干预,选用合适麻醉方法,避免肺动脉压力进一步升高,以提高产妇及新生儿的生存率。Objective To investigatethe keypoints for anestheticmanagement duringcaesarean section for pregnant patients with severe pulmonary hypertension.Methods A retrospective analysis was performed for theclinical data,anestheticmanagement,and postoperative outcome of 11 pregnant patients with severe pulmonary hypertension who underwent cesarean section.Results Pulmonary artery pressure ranged from 10.640 to 23.009 kPa in the 11 patients,with a mean pressure of(14.364±3.724)kPa.As for cardiac functional grading,there were 2 patients with gradeⅡcardiac function(18.2%),2 patients with gradeⅢcardiac function(18.2%),and 7 patients with gradeⅣcardiac function(63.6%),and 9 patients with gradeⅢ/Ⅳcardiac function received multidisciplinary consultation and drug therapy before surgery.During the surgery,10 patients(90.9%)received epidural anesthesia and 1 patient(9.1%)received general anesthesia,and related intervention measures were given to reduce volume load,dilate the pulmonary artery with drugs,prevent pulmonaryartery spasm,and reduce pulmonary artery pressure.All the 11 patients were transferred to the intensive care unitafter surgery,among whom 2 patients(18.2%)died of right heart failure and 9 patients(81.8%)were discharged successfully.One neonate(9.1%)died due topreterm birth,and the remaining 10 neonates(90.9%)survived.Conclusion Pregnant patientswith severe pulmonary hypertension tend to have poor cardiac function,which may easily lead to heart failure.Adequate evaluation and reasonable intervention should be performed during the perioperative period,and appropriate anesthesia methods should be selected to avoid the further increase inpulmonary artery pressure and improve the survival rates of parturients and neonates.

关 键 词：妊娠并发症 肺动脉高压 心力衰竭 剖宫产术 麻醉 

分 类 号：R714.7[医药卫生—妇产科学]