高海拔地区妊娠合并心衰剖宫产术围手术期的综合治疗

GENERAL TREATMENT OF PREGNANCY ASSOCIALTED WITH HEART FAILURE AT CESAREAN

目的：探讨高海拔地区妊娠晚期合并心衰剖宫产术过程中，在围手术期的更合理的综合治疗方法，并安全度过围手术期。方法：对在海拔２ ２６０ｍ ～３ ３００ｍ 地区５５例妊娠晚期合并心衰时用剖宫产结束妊娠患者为观察对象，在术前、术中及术后由麻醉医师、心内科医师及产科医师共同根据患者ＣＶＰ、ＳａＯ２、ＨＲ等连续监护，并采用综合有效地积极治疗，重症采用全麻ＰＥＥＰ，手术采用改良快速剖宫产术。结果：术前死亡１ 例，５４例经综合治疗同时行改良快速剖宫产术，产妇无术中、术后死亡，术中娩出新生儿全部存活１周以上，５４例孕产妇均安全渡过围手术期。结论：采用以心内科最新治疗技术为主的三科合作，利用改良快速剖宫产术，从切皮到胎儿娩出５ｍ ｉｎ 以内完成以及２０ｍ ｉｎ 左右完成手术全过程新术式，明显增加抢救成功率，对降低孕产妇合并心脏病死亡率有重要意义。

To explore a general method of treatment of pregnancy associated with heart fai lure at cesarean at high altitude.Methods:General therapy on basis of CVP,SaO 2,HR,operation,anesthesia etc,were performed in 55 subjects with pregnancy associated with heart failure at altitude of 2 260m～3 300m.Results:A case dead before cesarean,54 cases were generally treated with improved cesarean;all patients were survival during and after cesarean.Conclusions:The general theropeutic method is useful and secceed in the process of treatment of pregnancy associated with heart failure at cesarean.$$$$