Nagy C J, Wheeler A S, Archer T L
Department of Anesthesiology, University of Texas Health Science Center, San Antonio, Texas, USA.
Int J Obstet Anesth. 2008 Apr;17(2):159-63. doi: 10.1016/j.ijoa.2007.07.005. Epub 2008 Mar 4.
A Jehovah's Witness who had had four previous cesarean deliveries was referred to our institution for management of a complete placenta previa at 34 weeks of gestation. A subsequent ultrasound scan was suggestive of placenta percreta with bladder involvement. After erythropoietin and iron supplementation, cesarean hysterectomy was performed. Using PulseCO technology for continuous hemodynamic monitoring, preoperative acute normovolemic hemodilution and intraoperative cell salvage were used resulting in a successful cesarean hysterectomy with a 5500-mL estimated blood loss. The PulseCO system provides continuous, real-time hemodynamic data by applying pulse power analysis to the arterial pressure waveform. A bolus of oxytocin given after delivery produced profound hypotension, the hemodynamics of which were elucidated with the PulseCO system. To our knowledge, the combined use of acute normovolemic hemodilution, intraoperative cell salvage and PulseCO hemodynamic monitoring for cesarean hysterectomy has not been reported previously. These techniques may be particularly useful in managing patients who refuse blood products and/or in whom the baseline hemoglobin is suboptimal.
一名曾有过四次剖宫产史的耶和华见证人在妊娠34周时因完全性前置胎盘被转诊至我院。随后的超声扫描提示胎盘植入并累及膀胱。在补充促红细胞生成素和铁剂后，实施了剖宫产子宫切除术。采用PulseCO技术进行连续血流动力学监测，术前进行急性等容血液稀释并在术中进行细胞回收，成功完成了剖宫产子宫切除术，估计失血量为5500毫升。PulseCO系统通过对动脉压波形应用脉搏功率分析来提供连续、实时的血流动力学数据。分娩后给予的一剂催产素导致严重低血压，PulseCO系统阐明了其血流动力学情况。据我们所知，此前尚未报道过将急性等容血液稀释、术中细胞回收和PulseCO血流动力学监测联合用于剖宫产子宫切除术。这些技术在处理拒绝输血制品和/或基线血红蛋白不理想的患者时可能特别有用。
