Sepehripour Amir H, Lo Tammy T, Shipolini Alex R, McCormack David J
Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester, UK.
Interact Cardiovasc Thorac Surg. 2012 Dec;15(6):1063-70. doi: 10.1093/icvts/ivs318. Epub 2012 Sep 3.
A best evidence topic was written according to a structured protocol. The question addressed was whether cardiopulmonary bypass can be used safely with satisfactory maternal and foetal outcomes in pregnant patients undergoing cardiac surgery. A total of 679 papers were found using the reported searches of which 14 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Reported measures were maternal and foetal mortality and complications, mode of delivery, cardiopulmonary bypass and aortic cross-clamp times, perfusate flow rate and temperature and maternal NYHA functional class. The most recent of the best evidence studies, a retrospective observational study of 21 pregnant patients reported early and late maternal mortalities of 4.8 and 14.3%, respectively, and a foetal mortality of 14.3%. Median cardiopulmonary bypass and aortic cross-clamp times were 53 and 35 min, respectively, and the median bypass temperature was 37°C. Three larger retrospective reviews of the literature reported maternal mortality rates of 2.9-5.1% and foetal mortality rates of 19-29%. Mean cardiopulmonary bypass times ranged from 50.5 to 77.8 min. Another retrospective observational study reported maternal mortality of 13.3% and foetal mortality of 38.5%. Mean cardiopulmonary bypass and aortic cross-clamp times were 89.1 and 62.8 min, respectively, with a mean bypass temperature of 31.8°C. A retrospective case series reported no maternal mortality and one case of foetal mortality. Median cardiopulmonary bypass and aortic cross-clamp times were 101 and 88 min, respectively. Eight case reports described 10 patients undergoing cardiopulmonary bypass. There were no reports of maternal mortality and one report of foetal mortality. Mean cardiopulmonary bypass and aortic cross-clamp times were 105 and 50 min, respectively. We conclude that while the use of cardiopulmonary bypass during pregnancy poses a high risk for both the mother and the foetus, the use of high-flow, high-pressure, pulsatile, normothermic bypass and continuous foetal and uterine monitoring can allow cardiac surgery with the use of cardiopulmonary bypass to be performed with the greatest control of risk in the pregnant patient.
根据结构化协议撰写了一篇最佳证据主题。所探讨的问题是，在接受心脏手术的孕妇中，体外循环能否安全使用并获得令人满意的母婴结局。通过报告的检索共找到679篇论文，其中14篇代表了回答该临床问题的最佳证据。现将作者、日期、期刊、研究类型、人群、主要结局指标及结果制成表格列出。报告的指标包括母婴死亡率及并发症、分娩方式、体外循环及主动脉阻断时间、灌注液流速及温度以及母亲的纽约心脏协会（NYHA）心功能分级。最佳证据研究中最新的一项，对21例孕妇进行的回顾性观察研究报告称，早期和晚期母亲死亡率分别为4.8%和14.3%，胎儿死亡率为14.3%。体外循环和主动脉阻断时间的中位数分别为53分钟和35分钟，体外循环温度中位数为37°C。三项较大规模的文献回顾性研究报告母亲死亡率为2.9 - 5.1%，胎儿死亡率为19 - 29%。平均体外循环时间为50.5至77.8分钟。另一项回顾性观察研究报告母亲死亡率为13.3%，胎儿死亡率为38.5%。平均体外循环和主动脉阻断时间分别为89.1分钟和62.8分钟，平均体外循环温度为31.8°C。一项回顾性病例系列报告无母亲死亡，有1例胎儿死亡。体外循环和主动脉阻断时间的中位数分别为101分钟和88分钟。八篇病例报告描述了10例接受体外循环的患者。无母亲死亡报告，有1例胎儿死亡报告。平均体外循环和主动脉阻断时间分别为105分钟和50分钟。我们得出结论，虽然孕期使用体外循环对母亲和胎儿都构成高风险，但使用高流量、高压、搏动性、常温体外循环以及持续的胎儿和子宫监测，可在最大程度控制风险的情况下，让接受心脏手术的孕妇进行体外循环。
