妊娠合并巨大纵隔肿物患者在体外膜氧合 支持下行剖宫产术围手术期管理1例

Perioperative management of cesarean section in pregnant patient with macro mediastinal masses supported by membrane oxygenation:a case report

剖宫产术是抢救高危孕妇、挽救母子生命常采用的方法。合并纵隔肿物的孕妇,妊娠期渐进的气短、胸闷症状缺乏特异性;而出于对胎儿的保护,孕妇通常不进行影像学检查,导致了病情难以早期发现。晚期合并的呼吸衰竭及纵隔综合征给剖宫产术的麻醉带来了极大的风险和挑战。此例孕晚期孕妇急诊入院,合并明显的呼吸困难、纵隔综合征,术前紧急多学科会诊,建立了有效的呼吸循环支持方案,术中紧急处理急性气道塌陷的同时维持了循环、氧合、电解质的稳定,确保了剖宫产术的顺利进行,经过围手术期的综合救治,母子安全、平稳地度过围手术期,顺利康复出院。

Caesarean section is a common method used to save high‑risk pregnant women and save the lives of mothers and children.In a pregnant woman with a mediastinal mass,the symptom of progressive shortness of breath and chest tightness during preg‑nancy is not specific.It is difficult to detect the mediastinal disease early because pregnant women usually do not have an imaging ex‑amination to avoid harming the fetus.The advanced stage of the disease combined with respiratory failure and mediastinal syndrome brings great risks and challenges to the anesthesia of cesarean section.In this case,a pregnant woman in the third trimester was admit‑ted to the hospital as an emergency,complicated with obvious dyspnea and mediastinal syndrome.Emergency multidisciplinary consul‑tation was conducted before surgery,and an effective respiratory and circulatory support program was established.During the operation,acute airway collapse was treated urgently while maintaining the stability of circulation,oxygenation,and electrolyte,which ensured the caesarean section.After comprehensive perioperative treatment,the mother and child safely passed the perioperative period and recov‑ered,and were discharged from the hospital.