脑血管畸形术后连续蛛网膜下腔麻醉剖宫产1例

Continuous spinal anesthesia for 1 cases of cesarean section after cerebral vascular malformation

脑血管畸形术后行剖宫产术患者的术中麻醉管理最重要的是维持循环稳定性，避免BP过高引起颅内畸形及愈合后血管再次破裂，避免BP过低导致母体脑血流供应不足以及胎盘血流量减低导致的胎儿窘迫。连续蛛网膜下隙麻醉（continuous spinal anesthesia，CSA）通过微导管将药物注入蛛网膜下隙，具有起效快、自身血流动力学稳定的优势。通过此病例介绍对脑血管畸形术后行剖宫产术的麻醉管理的特殊性及CSA的优势之处。

Maintaining hemodynamic stability is the most important to the parturient woman who undergoing cesarean section after cerebral vascular malformation. Avoiding high blood pressure caused by intracranial deformity and vascular rupture again after healing, avoid low blood pressure leading to maternal cerebral blood flow insufficiency and fetal distress caused by decreased placental blood flow. Continuous spinal anesthesia （CSA） by microcatheter injection of drugs into the subarachnoid space, and can provide more stable hemodynamic status with rapid onset and perfect anesthetic effect in obstetric patients. Through this case, the particularity of caesarean section management and the advantages of CSA in patients with cerebral vascular malformation were introduced in this paper.