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[病例报告:剖宫产术中胎盘循环完整时胎儿气管插管的麻醉管理]

[Report of a case: the anesthetic management for fetal tracheal intubation with intact uteroplacental circulation during cesarean section].

作者信息

Yanamoto Fujio, Izumi Ryouhei, Tamaishi Kazumasa, Hirashima Kana, Tashiro Chikara

机构信息

Department of Anesthesiology, Hyogo College of Medicine, Nishinomiya 663-8501.

出版信息

Masui. 2003 Aug;52(8):886-9.

Abstract

We experienced a case of cesarean section in a patient with a fetus having a prenatally diagnosed huge cervical mass, which could cause airway obstruction immediately after delivery. The fetal cervical mass was confirmed at 19 gestational weeks, and amniocentesis was performed at 33 weeks. At 35 weeks, MRI showed the large mass that could disturb the airway patency after birth, and elective cesarean section was scheduled at 37 weeks. In the anesthetic management, anesthesia was maintained with isoflurane in oxygen, and ritodorine and nitroglycerin were used for obtaining uterine relaxation and keeping uteroplacental circulation. Fetal head was exposed from the uterine incision site and tracheal intubation was successfully performed. After confirming the neonatal oxygenation under manual ventilation, the baby was delivered. After delivery, the mass was diagnosed as cystic hygroma and he was maintained under mechanical ventilation in NICU. Five months later subtotal excision of the cervical cystic hygroma and tracheostomy were performed.

摘要

我们遇到一例剖宫产病例,患者的胎儿产前诊断出巨大的颈部肿块,这可能在分娩后立即导致气道阻塞。胎儿颈部肿块在孕19周时得到确认,孕33周时进行了羊水穿刺。孕35周时,磁共振成像显示该巨大肿块可能会在出生后干扰气道通畅,因此计划在孕37周进行择期剖宫产。在麻醉管理方面,采用异氟烷在氧气中维持麻醉,并使用利托君和硝酸甘油来实现子宫松弛并维持子宫胎盘循环。从子宫切口处暴露胎儿头部并成功进行气管插管。在确认手动通气下新生儿的氧合情况后,娩出婴儿。分娩后,肿块被诊断为囊状水瘤,婴儿在新生儿重症监护病房接受机械通气。五个月后,进行了颈部囊状水瘤次全切除术和气管造口术。

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