Kozono Yuki, Wakabayashi Saiko, Ando Nozomi, Asano Mineko, Hara Atsuko, Hasegawa Maiko, Sonoda Seijirou, Inada Eiichi
Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo 113-8431.
Masui. 2011 Jan;60(1):107-10.
A 31-year-old primigravida was admitted for control of twin gestation and delivery. At 36-week gestation, an emergent cesarean section was performed under combined spinal-epidural anesthesia because of progression of PIH. Anesthetic course was uneventful until the operation was finished. An hour later, systolic blood pressure started to decline to reach about 70 mmHg and Sp(O2) about 80%. Pleural effusion was observed in the chest X-ray on post-operative day 1. Echocardiography showed akinesis of the antero-septal wall with ejection fraction (EF) of 47%. Peripartum cardiomyopathy (PPCM) was strongly suspected. HELLP syndrome and DIC were also combined with PPCM, so intensive care was given to her from the 1st POD. Symptoms of heart failure were alleviated by furosemide and carperitide by the 12th POD. The EF increased to 58% on the 11th POD.
一名31岁初产妇因双胎妊娠及分娩控制入院。孕36周时，因妊娠期高血压疾病进展，在腰麻-硬膜外联合麻醉下行急诊剖宫产术。手术结束前麻醉过程顺利。1小时后，收缩压开始下降至约70mmHg，血氧饱和度（Sp(O2)）约为80%。术后第1天胸部X线检查发现胸腔积液。超声心动图显示前间隔运动减弱，射血分数（EF）为47%。高度怀疑围产期心肌病（PPCM）。HELLP综合征和弥散性血管内凝血（DIC）也与PPCM合并存在，因此自术后第1天起对她进行重症监护。至术后第12天，通过呋塞米和卡培立肽，心力衰竭症状得到缓解。术后第11天EF升至58%。
