妊娠中晚期患者在体外循环下行心血管手术的麻醉管理

Anesthesia management for middle and late pregnant patients with cardiovascular surgery under cardiopulmonary bypass

目的探讨妊娠中晚期患者在体外循环下行心血管手术的麻醉管理策略。方法回顾性分析该院自2016年1月至2019年9月妊娠中晚期患者7例在体外循环下行心血管手术的围术期麻醉资料。所有患者均采用静吸复合全身麻醉。继续妊娠患者采用咪达唑仑、依托咪酯和瑞芬太尼进行麻醉诱导,以瑞芬太尼静脉泵注复合七氟烷吸入维持麻醉,体外循环采用常温高流量灌注技术,围术期持续胎心监测。同期手术患者,麻醉诱导采用七氟烷吸入、瑞芬太尼静脉泵注,先行剖宫产术,胎儿断脐后以舒芬太尼静脉泵注、七氟烷吸入维持麻醉,再行心血管手术。结果3例保留妊娠先行心血管手术,后期再行剖宫产术;4例同期行剖宫产术与心血管手术。7例患者均康复出院,所有胎儿均存活,除3例术后发生新生儿肺炎外,无其他相关并发症。结论妊娠中晚期患者在体外循环下行心血管手术风险极高,制订个体化围术期麻醉管理策略有助于降低妊娠中晚期患者心血管手术的围术期风险。

Objective To explore the anesthesia management strategies of middle and late pregnant patients undergoing cardiovascular surgery under cardiopulmonary bypass(CPB).Methods The anesthetic management data in the middle and late pregnant patients undergoing cardiovascular surgery under CPB in this hospital from Jan.2016 to Sep.2019 were retrospectively analyzed.All cases adopted the intravenous inhalation combined general anesthesia.The patients with continued pregnancy adopted midazolam,etomidate and remifentanil for conducting the anesthesia induction,intravenous pump infusion of remifentanil and inhalation of sevoflurane for maintaining anesthesia,CPB adopted the normal temperature and high flow perfusion technique,and the fetal heart rate was persistently monitored during the perioperative period.For pregnant patients undergoing simultaneous surgery,sevoflurane inhalation and intravenous pump infusion of remifentanil were used for anesthesia induction.Cesarean section was first performed,intravenous infusion of sufentanil and sevoflurane inhalation were used to maintain anesthesia after omphalotomy,and then cardiovascular surgery was performed.Results Three cases of pregnancy reservation underwent cardiac surgery first,and the cesarean section was performed in the late period.The four cases underwent cesarean section and cardiovascular surgery simultaneously.All the 7 cases were recovered and discharged.All fetuses were alive.There were no other related complications except for 3 cases of newborn pneumonia at birth.Conclusion The risk for middle and late pregnant patients undergoing cardiovascular surgery with CPB is extremely high.Formulating the individualized perioperative anesthesia management strategy is helpful to reduce the perioperative risk of cardiovascular surgery in middle and late pregnant patients.