妊娠合并中重度脊柱侧凸的麻醉管理

Anesthesia management of pregnancy with moderate to severe scoliosis

目的 探讨妊娠合并中重度脊柱侧凸产妇的分娩及麻醉管理特点,总结妊娠合并脊柱侧凸的麻醉实施策略。方法 回顾性纳入2020年1月-2022年1月四川大学华西第二医院收治的妊娠合并中重度脊柱侧凸产妇。分析产妇的人口学信息、分娩方式及麻醉实施方案等相关数据。结果 共纳入中重度脊柱侧凸产妇9例,平均年龄29.9岁。产妇的Cobb角中位数(下四分位数,上四分位数)为42°(35°,54°)。5例产妇存在肺通气功能中重度受损,1例产妇为心功能Ⅲ级,8例产妇存在合并症。8例选择剖宫产的产妇中3例行全身麻醉,4例行硬膜外阻滞,1例行局部麻醉+强化镇静;1例选择阴道分娩的产妇行硬膜外分娩镇痛。所有产妇均安全度过手术或分娩期,5例术后转入重症监护病房继续治疗,4例术后安返病房,所有产妇均痊愈出院。8例胎儿成活,1例胎儿致死性引产。结论 妊娠合并中重度脊柱侧凸产妇因伴有严重畸形及器官功能损害,特别是心肺功能异常,而对阴道分娩耐受极差,大多数以剖宫产终止妊娠,在进行麻醉方案抉择时,应结合产妇自身状况及手术风险谨慎选择。

Objective To discuss the characteristics of delivery and anesthesia management of pregnant women with moderate to severe scoliosis,and to summarize the anesthesia implementation strategies for pregnant women with scoliosis.Methods Pregnant women with moderate to severe scoliosis admitted to West China Second University Hospital,Sichuan University between January 2020 and January 2022 were retrospectively included.The demography information,delivery mode,anesthesia implementation plan and other relevant data of the women were analyzed.Results A total of 9 women with moderate to severe scoliosis were included,with an average age of 29.9 years.The median(lower quartile,upper quartile)of the Cobb angle of the women was 42°(35°,54°).There were 5 women with moderate to severe impairment of lung ventilation function,1 woman with gradeⅢheart function,and 8 women with comorbidities.Among the 8 women who underwent cesarean section,3 underwent general anesthesia,4 underwent epidural block,and 1 underwent local anesthesia with enhanced sedation.One woman who chose vaginal delivery underwent epidural labor analgesia.All women passed the surgery or delivery period safely,with 5 transferred to the intensive care unit for further treatment after surgery,and 4 safely returned to the ward after surgery.All women recovered and were discharged.Eight fetuses survived,and 1 fetus underwent lethal induced abortion.Conclusions Pregnant women with moderate to severe scoliosis during pregnancy have poor tolerance to vaginal delivery due to severe malformations and organ dysfunction,especially cardiopulmonary dysfunction.Most of them terminate pregnancy through cesarean section.When making anesthesia decisions,it is important to carefully consider the women’s own condition and surgical risks.