文章摘要
先天性心脏病合并重度肺动脉高压产妇剖宫产不同麻醉方式对预后的影响
Effect of different anesthesia methods on prognosisfor cesarean section in parturients with congenital heart disease complicated with severe pulmonary hypertension
  
DOI：10.12089/jca.2019.08.010
中文关键词: 重度肺动脉高压  剖宫产  麻醉
英文关键词: Severe pulmonary arterial hypertension  Cesarean section  Anesthesia
基金项目:
作者单位E-mail
范倩倩 710032,西安市,空军军医大学西京医院麻醉与围术期医学科  
朱正华 710032,西安市,空军军医大学西京医院麻醉与围术期医学科  
路志红 710032,西安市,空军军医大学西京医院麻醉与围术期医学科  
董海龙 710032,西安市,空军军医大学西京医院麻醉与围术期医学科  
熊利泽 710032,西安市,空军军医大学西京医院麻醉与围术期医学科（现在同济大学附属上海市第四人民医院麻醉科及脑功能与人工智能转化研究所） mzkxlz@126.com 
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中文摘要:
      
目的 探讨先天性心脏病合并重度肺动脉高压产妇剖宫产术的麻醉管理经验并比较不同麻醉方式对预后的影响。
方法 回顾性分析自2012年1月至2017年12月收治的先天性心脏病合并重度肺动脉高压（PAH）行剖宫产术的产妇共37例，按麻醉方式的不同分为两组：全身麻醉组（A组，n=18）和椎管内麻醉组（B组，n=19）。收集两组产妇术前基本情况；收集两组产妇术后机械通气时间、ICU停留时间、术后住院时间及术后不良事件；收集新生儿出生体重和新生儿窒息情况。
结果 两组产妇年龄、孕周、孕产史、术前肺动脉压力、血氧饱和度、围术期并发症、新生儿窒息率差异无统计学意义。A组术前NYHA分级Ⅳ级有10例明显多于B组的2例；A组术前NYHA分级Ⅱ级有3例明显少于B组的9例（P<0.05）。A组术后机械通气时间、ICU停留时间及术后住院时间明显长于B组（P＜0.05）。
结论 先天性心脏病合并重度PAH产妇剖宫产术麻醉方式的选择需结合自身情况，术前NYHA Ⅰ—Ⅱ级的产妇可采用椎管内麻醉，氧合欠佳、心功能差的产妇仍推荐使用全身麻醉。
英文摘要:
      
Objective To investigate the anesthesia management for cesarean section in patients with congenital heart disease complicated with severe pulmonary arterial hypertension (PAH) and to compare the effects of different anesthesia methods on prognosis of patients.
Methods Thirty-seven cases of patients with congenital heart disease complicated with severe PAH underwent cesarean section in Xijing hospital from January 2012 to December 2017 were analyzed retrospectively. Patients were divided into two groups according to anesthesia methods, general anesthesia group (group A, n=18) and intravertebral group (group B, n = 19). Patients' preoperative general information, postoperative mechanical ventilation time, the length of ICU stay and hospital stay after surgery, and the outcomes of parturients and newborns were compared between the two groups.
Results There were no significant differences in maternal age, pregnant weeks, pregnancy history, preoperative pulmonary artery pressure, SpO2, perioperative complications and neonatal asphyxia rate between the two groups. The proportion of patients with preoperative NYHA class Ⅳ in group A was significantly higher than that of group B and the proportion of patients with preoperative NYHA class Ⅱ in group A was significantly lower than that in group B(P < 0.05). Postoperative mechanical ventilation time, length of ICU and hospital stay of parturients were significant longer in group A than in group B (P < 0.05). There were no significant differences in postoperative complications and neonatal asphyxia rate between the two groups. All parturients and newborns were discharged safely.
Conclusion The way of anesthesia in cesarean section for patients with congenital heart disease complicated with severe PAH should be chosen according to patients' preoperative situation. Intra-spinal anesthesia can be used for patients with NYHA class Ⅰ-Ⅱ. For patients with poor oxygenation and cardiac function, general anesthesia is recommended.
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