Korsten H H, Van Zundert A A, Mooij P N, De Jong P A, Bavinck J H
Department of Anesthesiology, Catharine Hospital, Eindhoven, The Netherlands.
Acta Anaesthesiol Belg. 1989;40(3):201-5.
The incidence of heart disease during pregnancy has declined from 3.6% to approximately 1.5% over the last 25 years as a result of better medical and surgical care. Rheumatic heart disease still accounts for 75% of cases and the incidence of bacterial endocarditis during pregnancy is about 1 in 8000. Seaworth and Durack reviewed 124 cases found in the literature of a 40 year period. The experience of any anesthetist with such cases will thus be limited. In this case report a patient is described who required emergency aortic valve replacement in the 24th week of pregnancy. The effect of the non-pulsatile flow during the extracorporeal circulation on the foetal unit will be discussed. Recommendations for the perioperative management include a normothermic high flow, high pressure perfusion technique, monitoring of foetal heart rate and uterine activity and vigorous tocolysis using beta sympathomimetics and progesterone.
由于医疗和外科护理水平的提高，过去25年中孕期心脏病的发病率已从3.6%降至约1.5%。风湿性心脏病仍占病例的75%，孕期细菌性心内膜炎的发病率约为八千分之一。西沃思和杜拉克回顾了40年间文献中报道的124例病例。因此，任何麻醉医生处理这类病例的经验都会有限。在本病例报告中，描述了一名在孕24周时需要紧急进行主动脉瓣置换的患者。将讨论体外循环期间非搏动性血流对胎儿的影响。围手术期管理的建议包括常温高流量、高压灌注技术，监测胎儿心率和子宫活动，以及使用β-拟交感神经药和孕酮进行积极的宫缩抑制。
