Takano Yasuaki, Matsuyama Hiroki, Fujita Akiko, Kobayashi Atsuko, Kawamura Mitsuyoshi
Department of Anesthesia, Saiseikai Suita Hospital, Osaka 564-0013.
Masui. 2003 Oct;52(10):1086-8.
A 31-year-old woman underwent urgent aortic valve replacement due to infective endocarditis at 16 weeks' gestation. Because of rapid and severe congestive heart failure, maternal rescue was regarded as the priority in the anesthetic management. Previous literature shows that high-flow high-pressure normothermic perfusion during cardiopulmonary bypass provides the best way of reducing fetal risk. Though it was not performed, the fetus was alive for 24 hours after the operation. Perioperative administration of dopamine and furosemide could have diminished uterine blood flow. If these drugs could have been avoided, the fetus may have stayed alive. However, considering the risk of teratogenesis due to drug administration and cardiopulmonary bypass, propriety of pregnancy prolongation is controversial.
一名31岁女性在妊娠16周时因感染性心内膜炎接受了紧急主动脉瓣置换术。由于迅速出现严重的充血性心力衰竭,麻醉管理中以挽救产妇生命为首要任务。既往文献表明,体外循环期间采用高流量、高压、常温灌注是降低胎儿风险的最佳方法。尽管未采用该方法,但术后胎儿存活了24小时。围手术期使用多巴胺和呋塞米可能减少了子宫血流。如果能避免使用这些药物,胎儿或许能存活下来。然而,考虑到药物使用和体外循环导致胎儿致畸的风险,延长妊娠是否恰当存在争议。