Handa F, Ohnishi Y, Takauchi Y, Kuro M
Department of Anesthesiology, National Cardiovascular Center, Suita 565-8565.
Masui. 2001 Apr;50(4):399-404.
Ten pregnancies and 7 deliveries in 5 patients of Marfan syndrome were managed at our institution. Three patients were delivered with a cesarean section under general anesthesia, and one was delivered under epidural anesthesia. Three underwent vaginal delivery with epidural anesthesia. Two patients selected induced abortion, and one had a spontaneous abortion. Six of 7 neonates and all 5 mothers survived without any sequela. One had intrauterine fetal death due to dissection of aortic aneurysm. Simultaneous cesarean section and cardiovascular operation under cardiopulmonary bypass were performed in one case. In the parturient without progress of cardiovascular complication during pregnancy, painless labor under epidural anesthesia is our first choice to minimize hemodynamic derangement. Invasive arterial blood pressure and central venous pressure were monitored in all cases of vaginal delivery for tight hemodynamic control. Epidural anesthesia is also preferred in cases of elective cesarean section for obstetric indication. Emergency cesarean sections are performed in the cases of progressive dissection and urgent obstetric indication. General anesthesia was induced with fentanyl and midazolam to minimize cardiovascular response to tracheal intubation. We emphasize that evaluation of cardiovascular status and multidisciplinary approach are the key in the anesthetic management of parturients with Marfan syndrome.
我们机构对5例马凡综合征患者的10次妊娠和7次分娩进行了处理。3例患者在全身麻醉下剖宫产分娩，1例在硬膜外麻醉下分娩。3例在硬膜外麻醉下经阴道分娩。2例患者选择了人工流产，1例自然流产。7例新生儿中的6例和所有5位母亲均存活且无任何后遗症。1例因主动脉瘤夹层导致宫内胎儿死亡。1例患者在剖宫产同时进行了体外循环下的心血管手术。对于孕期心血管并发症无进展的产妇，硬膜外麻醉下的无痛分娩是我们的首选，以尽量减少血流动力学紊乱。所有经阴道分娩的病例均监测有创动脉血压和中心静脉压，以严格控制血流动力学。对于因产科指征而行择期剖宫产的病例，也首选硬膜外麻醉。对于进行性夹层和紧急产科指征的病例，则行急诊剖宫产。使用芬太尼和咪达唑仑诱导全身麻醉，以尽量减少气管插管对心血管的反应。我们强调，心血管状态评估和多学科方法是马凡综合征产妇麻醉管理的关键。
