重度肺动脉高压产妇术中肺高压危象的麻醉管理

Management of anesthesia for pulmonary hypertension crisis in obstetric operation for women with severe pulmonary hypertension

目的:分析重度肺动脉高压(PAH)产妇术中肺动脉高压危象(PHC)的临床特点和麻醉管理。方法:回顾性分析北京安贞医院2008年2月至2016年11月间,施行的共148例妊娠合并重度PAH产妇,在剖宫产或剖宫取胎术中11例发生PHC的临床资料。结果:在148例患者中11例术中发生PHC,术中危象发生率为7.4%(11/148),10例患者行连续硬膜外麻醉,1例行单次腰麻。1例患者在漂浮导管导管置入后发生肺高压危象,1例剖宫取胎患者在全麻恢复苏醒时发生肺高压危象,6例患者在胎儿娩出时出现,3例在胎儿娩出后10min左右发生严重的PHC。3例患者经治疗后病情平稳,恢复正常后出院,8例患者经积极抢救无效死亡,病死率为72.7%。结论:重度PAH产妇术中发生PHC的病死率极高。因此,术前充分改善患者全身情况,术中完善的监测,选择硬膜外麻醉,预防性、合理应用心血管活性药物,危象发作时及时积极抢救等至关重要。

Objective： To analyze management of anesthesia for pulmonary hypertension crisis in obstetric operation for women with severe pulmonary hypertension. Methods：Review Beijing anzhen hospital, from February 2008 to August 2016,148 cases of pregnant women with severe pulmonary hypertension, underwent cesarean delivery or termination of pregnancy, analyze cases who had intraoperative pulmonary hypertension crisis occurred. Results：A total of 11 patients who had intraoperative pulmonary hypertension crisis occurred ,the rate is 7.4% （11/18）. 10 cases underwent continuous epidural anesthesia, 1 case underwent spinal anesthe- sia. After the Swan-Ganz catheter placement, 1 case was in pulmonary hypertension crisis. 1 case, when recov- er from general anesthesia,pulmonary hypertension crisis happened. 6 patients at fetal childbirth, 3 cases at a- bout 10 minutes after the delivery, get severe pulmonary hypertension crisis. 3 cases leave the hospital healthy, 8 cases died, the mortality was 72. 7%. Conclusion：Pulmonary hypertension crisis is very dangerous for gravida with severe pulmonary hypertension pulmonary, the mortality rate is very high. Improve eardiopulmonary function of patients before the operation, perfect the intraoperative monitoring, choose epidural anesthesia, preventive use of cardiovascular drugs, timely treatment for crisis is very important.