Chen Hsiu-Pin, Sung Wei-Che, Hui Yu-Ling, Hui Chung-Kun
Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang Gung Med J. 2011;34(6 Suppl):28-33.
The number of pregnant women with cardiac disease is increasing with improvements in technology. In addition, more people are part of the national health insurance plan. However, there are few reports concerning the best method for anesthesia and mode of delivery in these high-risk patients. We report a 29-year-old woman scheduled for a planned caesarean section, who had a history of severe peripartum cardiomyopathy requiring extracorporeal membrane oxygenation in a previous pregnancy. The patient had regular prenatal care in our obstetric clinic. At 29 weeks' gestation, she developed severe dyspnea. A chest radiograph revealed bilateral pulmonary edema and 2-dimensional echocardiography showed a global hypokinesis and severe valve regurgitation with left ventricular ejection fraction of 41.2%. She had an emergency caesarean section and a cardiovascular surgeon was consulted to stand-by. Anesthesia was induced by ketamine 25 mg, midazolam 2.5 mg and rocuronium 50 mg for rapid intubation. The patient tolerated the procedure well and was extubated on postoperative day 1. She was discharged one week after surgery. Postoperatively, the patient was followed in the obstetric and cardiovascular surgery outpatient departments and at 5 months after surgery she was in good condition without any complaints.
随着技术的进步，患有心脏病的孕妇数量正在增加。此外，更多的人加入了国家医疗保险计划。然而，关于这些高危患者的最佳麻醉方法和分娩方式的报道却很少。我们报告了一名计划进行剖宫产的29岁女性，她有严重围产期心肌病病史，在前次妊娠时需要体外膜肺氧合治疗。该患者在我们的产科门诊接受了常规产前检查。妊娠29周时，她出现严重呼吸困难。胸部X线片显示双侧肺水肿，二维超声心动图显示全心运动减弱、严重瓣膜反流，左心室射血分数为41.2%。她接受了急诊剖宫产，并请心血管外科医生待命。通过静脉注射氯胺酮25mg、咪达唑仑2.5mg和罗库溴铵50mg诱导麻醉以进行快速插管。患者对手术耐受良好，术后第1天拔除气管插管。术后1周出院。术后，患者在产科和心血管外科门诊接受随访，术后5个月时状况良好，无任何不适主诉。
