妊娠期合并甲亢的产妇剖宫产术围术期管理方法研究进展

发布时间：2018-05-09 02:21

本文选题：妊娠 + 甲状腺功能亢进症　；参考：《山东医药》2015年35期

【摘要】：妊娠期合并甲状腺功能亢进症(甲亢)是高危妊娠,合理的围术期管理对母胎安全至关重要。妊娠合并甲亢产妇剖宫产术围术期术前应综合评估产妇的产程、胎儿情况、甲亢控制情况、有无气道受压、用药情况、合并疾病、既往病史、术前禁饮禁食情况等。患者术前用药主要有抗甲状腺药物、碘剂、β受体阻滞剂等。对于术前甲亢症状控制良好且无甲亢性心脏病、子痫、心力衰竭等并发症的患者,在排除凝血功能障碍、脊髓或脊神经根病变等椎管内麻醉禁忌后,可优先考虑椎管内麻醉。若患者合并有甲亢性心肌病、重度子痫、心力衰竭等严重并发症,应首选对循环动力学影响小的全麻。局麻药对母胎影响小,可安全用于产妇。静脉麻醉药亦可用于此类产妇麻醉,但应注意对新生儿呼吸的抑制作用。无论是进行椎管内麻醉还是全麻、入普通病房还是ICU的患者,均应加强甲状腺功能的监测和甲亢的治疗,及时对甲亢危象进行诊治。
[Abstract]:Pregnancy with hyperthyroidism (hyperthyroidism) is a high risk pregnancy. During the perioperative period of cesarean section for pregnant women with hyperthyroidism, comprehensive evaluation should be made on the delivery process, fetal condition, control of hyperthyroidism, airway pressure, medication, combined diseases, past medical history and fasting before operation. Patients before the use of antithyroid drugs, iodine, 尾-blockers and so on. For patients without complications of hyperthyroidism such as heart disease, eclampsia, heart failure and other complications before operation, patients with hyperthyroidism symptoms were excluded from contraindications of spinal cord or spinal nerve root diseases. If patients with hyperthyroidism cardiomyopathy, severe eclampsia, heart failure and other serious complications, should be preferred to have little impact on circulation dynamics of general anesthesia. Local anesthetic has little effect on mother and fetus and can be safely used in parturient. Intravenous anesthetics can also be used in this kind of parturient anesthesia, but attention should be paid to the inhibition of neonatal respiration. Patients who received intravertebral anesthesia or general anesthesia, general ward or ICU should strengthen the monitoring of thyroid function and the treatment of hyperthyroidism, and timely diagnosis and treatment of hyperthyroidism crisis.
【作者单位】：皖南医学院弋矶山医院;
【分类号】：R714.7

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