Tsutsumi Yusuke, Mizuno Ju, Takada Shinji, Morita Shigeho
Department of Anesthesiology, Teikyo University School of Medicine, Tokyo 173-8606.
Masui. 2010 Mar;59(3):379-82.
Eisenmenger's syndrome is defined as the process in which a left-to-right shunt due to an atrial (ASD) or ventricular septal defect (VSD) in the heart causes increased pulmonary blood flow, leading to pulmonary hypertension, which in turn, ultimately results in increased pressure in the right side of the heart and reversal of the shunt to right-to-left. Therefore, anesthetic management of Eisenmenger's syndrome is often difficult. We described a case of paracervical block for dilatation and curettage in a parturient with Eisenmenger's syndrome in this report. A 29-year-old woman with Eisenmenger's syndrome due to ASD became pregnant. She had dyspnea, cyanosis, and clubbed fingers. Her activity of daily life was in a wheel chair, and she was evaluated as New York Heart Association (NYHA) class IV. Her oxygen saturation by pulse oxymeter (Sp(O2)) showed 78-82% in room air. Dilatation and curettage was scheduled in the sixth week of her pregnancy. We performed paracervical block in the direction of 4 and 8 o'clock using 1% lidocaine 12 ml under 6 l x (min(-1) oxygen inhalation through a face mask. Seven minutes after the beginning of the operation, Sp(O2) temporarily decreased to 77% due to abdominal pain by surgical procedures. The operation was finished within 8 minutes. She had no adverse events postoperatively. The anesthetic goal for Eisenmenger's syndrome is to avoid hemodynamic changes that can worsen hypoxemia through an increase in right-to-left shunt. Paracervical block is safe and effective conduction anesthesia for dilatation and curettage in a parturient with Eisenmenger's syndrome.
心脏中的房间隔缺损（ASD）或室间隔缺损（VSD）导致的左向右分流过程，引起肺血流量增加，进而导致肺动脉高压，最终又导致右心压力升高以及分流方向逆转至右向左。因此，艾森曼格综合征的麻醉管理通常很困难。在本报告中，我们描述了1例患有艾森曼格综合征的产妇在扩张刮宫术中采用宫颈旁阻滞的病例。1名因ASD导致艾森曼格综合征的29岁女性怀孕。她有呼吸困难、发绀和杵状指。她日常生活需借助轮椅，被评估为纽约心脏协会（NYHA）IV级。她在室内空气中经脉搏血氧仪测得的氧饱和度（Sp（O₂））为78% - 82%。计划在其怀孕第6周时进行扩张刮宫术。我们在面罩吸氧6 L/min的情况下，于4点和8点方向使用12 ml 1%利多卡因进行宫颈旁阻滞。手术开始7分钟后，由于手术操作引起的腹痛，Sp（O₂）暂时降至77%。手术在8分钟内完成。她术后未出现不良事件。艾森曼格综合征的麻醉目标是避免因右向左分流增加而导致低氧血症恶化的血流动力学变化。宫颈旁阻滞对于患有艾森曼格综合征的产妇进行扩张刮宫术是一种安全有效的传导麻醉方法。
