33例风湿性心脏病合并妊娠的剖宫产麻醉处理

Anesthesia management of cesarean section for pregnant women with rheumatic heart diseases

目的:探讨风湿性心脏病(以下简称风心病)合并妊娠剖宫产的麻醉处理及围术期的综合治疗。方法:对33例妊娠合并风心病剖宫产的临床资料进行回顾性分析。28例产妇选用腰麻-硬脊膜外联合麻醉(简称硬脊麻),2例选用硬膜外麻醉(简称硬外麻),1例因术前出现严重心衰及2例需同时行瓣膜置换+取栓术而行全身麻醉(全麻)。术前、术中积极防治心衰,对已行换瓣术后的产妇围术期合理应用抗凝剂。结果:麻醉过程多数平稳,新生儿除全麻的2例病例Apgar评分在2-3分外,其余均在8分以上,母婴均安全度过围手术期,无1例死亡。仅一例因宫腔出现活动性出血,止血效果差而行全宫切除术,余病例无出现围术期大出血危情。结论:硬脊麻用于风心病合并妊娠剖宫产手术是安全有效的,术前、术中积极正确地防治心衰、改善心功能等综合治疗及围术期合理应用抗凝剂,可降低母婴死亡率。

Aim： To study the anesthesia management and perioperative therapy of caesarean section for pregnant women with rheumatic heart disease. Methods： The clinical data of 33 pregnant womem with rheumatic heart disease undergoing caesarean section retrospectively were analysed. Twenty- eight received combined epidural -spinal anesthesia （ES）. Two received epidural anesthesia （EA） , and 3 received general anesthesia （GA） , one because of the severe heart failure before operation, another 2 undergoing valve replacement and embolus elimination while caesarean section. The heart failure was actively prevented and treated and anticoagulant for pregnancy women who had valve replacement perioperative course was properly used. Results： Of all consecutine patients studied, the anesthesia effect was good and the patients＇ vital signs were stable. The Apgar scales of neonate are over 8 except that 2 of the GA cases are between 2 - 3. There was no maternal or neo nate death. Only 1 received total uterus resection because of the continuing active intrauterine bleeding and other patients had no hemorrhage crisis in perioperative period. Conclusions： Combined epidural- spinal anesthesia is safe and effective for pregnant women with RHD who are performed cesarean section. Actively integrated treatment and reasonable use of anticoagulant can reduce the mortality of the mother and neonate.