重度肺动脉高压孕妇终止妊娠的麻醉管理

Anesthesia management of pregnancy termination with severe pulmonary hypertension

目的:探讨妊娠合并重度肺动脉高压孕妇终止妊娠的麻醉管理。方法:对首都医科大学附属北京安贞医院2016年1月至2021年10月间,行终止妊娠的重度肺动脉高压孕妇临床资料进行回顾性分析。结果:在此期间接受终止妊娠的42例重度肺动脉高压孕妇平均年龄为(27.43±4.84)岁,平均肺动脉收缩压为(102.3±21.83)mmHg(1mmHg=0.133kPa),10例孕妇选择了同步绝育(23.8%)。早期妊娠(0~13周)共25例,其中22例于静脉麻醉下行电吸人流术,3例行人工流产钳刮术,分别为2例静脉麻醉和1例硬脊膜外阻滞。中期妊娠(14~27周)共17例,全部于椎管内麻醉下行子宫切开终止妊娠术,其中15例为硬脊膜外阻滞,1例为蛛网膜下隙阻滞,1例为蛛网膜下隙与硬脊膜外联合阻滞(CSEA)。42例孕妇中41例正常出院,1例死亡。结论:妊娠合并重度肺动脉高压的孕妇行早中期终止妊娠手术风险高,需针对不同妊娠时期和孕妇个体差异选择适当的麻醉方法与管理策略。

Objective:To investigate the anesthesia management of pregnancy termination with severe pulmonary hypertension.Methods:All the pregnant women with severe pulmonary hypertension who underwent pregnancy termination in 5 years(from January 2016 to October 2021)in Beijing Anzhen hospital affiliated to capital medical university were retrospectively analyzed.Results:During this period,the average age of 42 pregnant women with severe pulmonary hypertension who underwent pregnancy termination was(27.43±4.84).The mean pulmonary artery systolic blood pressure was(102.3±21.83)mmHg.10 cases were simultaneously sterilized with the termination of pregnancy(23.8%).There were 25 cases in early pregnancy(0-12 weeks),of which 22 cases underwent electric suction abortion under general anesthesia,3 cases underwent artificial abortion forceps curettage with 2 cases of general anesthesia and 1 case of epidural anesthesia.There were 17 cases in mid-pregnancy(13-27 weeks),all of which underwent hysterotomy to terminate pregnancy under intrathecal anesthesia,including 15 cases of epidural anesthesia,1 case of spinal anesthesia,and 1 case of combined spinal and epidural anesthesia.41 cases were discharged from hospital with good outcomes while unfortunately 1 case died.Conclusions:Pregnant women with severe pulmonary hypertension are at very high risk.It is vital for anesthesiologists to select appropriate anesthesia methods and management strategies according to different pregnancy periods and individual differences.