妊娠合并重度特发性肺动脉高压剖宫产围麻醉期处理及转归

发布时间：2018-08-24 11:27

【摘要】：【目的】分析妊娠合并重度特发性肺动脉高压患者围术期的麻醉处理方法,进一步优化此类产妇的治疗方案。【方法】回顾性分析2013年1月至2016年2月首都医科大学附属北京安贞医院收治的10例妊娠合并特发性肺动脉高压患者术前的一般资料、血流动力学参数、心功能分级、麻醉方法等临床资料并进行总结分析。【结果】10例患者平均终止妊娠孕周为(28.8±6.7)周,平均住院时间为(14.7±11.8)d,2例患者分别于孕16周、孕21周行剖宫取胎术终止妊娠,3例患者分别于术后第2~4天死亡,余存活至随访结束。所有产妇在胎儿娩出前后血流动力学变化明显,手术前后变化无差异。除2例中孕期剖宫取胎术死亡外,余8例全部存活。【结论】妊娠合并特发性肺动脉高压孕妇病死率高,不宜妊娠,一旦妊娠应立即终止。此类产妇麻醉风险极大,应多学科综合评估、制定精准诊疗方案。
[Abstract]:[objective] to analyze the anesthetic management of severe idiopathic pulmonary hypertension in pregnancy during perioperative period. [methods] the general data of 10 pregnant women with idiopathic pulmonary hypertension admitted to Beijing Anzhen Hospital affiliated to Capital Medical University from January 2013 to February 2016 were analyzed retrospectively. The clinical data of hemodynamic parameters, cardiac function grading and anesthesia methods were summarized and analyzed. [results] the average termination of pregnancy was (28.8 卤6.7) weeks in 10 patients, and the average hospitalization time was (14.7 卤11.8) days in 2 patients at 16 weeks of pregnancy. At 21 weeks of gestation, 3 patients with termination of pregnancy died on the 2nd day after pregnancy, and survived until the end of follow-up. The hemodynamic changes of all parturients were obvious before and after delivery, but there was no difference before and after operation. All of the 8 cases survived except 2 cases died during pregnancy. [conclusion] the mortality of pregnancy with idiopathic pulmonary hypertension is high, it is not suitable for pregnancy, once pregnancy should be terminated immediately. This kind of parturient anesthetic risk is extremely high, should be multi-disciplinary comprehensive assessment, develop accurate diagnosis and treatment plan.
【作者单位】：北京市中西医结合医院麻醉科;首都医科大学附属北京安贞医院麻醉中心;
【基金】：首都临床特色应用研究与成果推广项目(Z151100004015022)
【分类号】：R614

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