Bautin A E, Yakubov A V, Kokonina Yu A, Il'in A B, Li O A, Irtyuga O B, Mazurok V A, Zazerskava I E, Moiseeva O M
Anesteziol Reanimatol. 2016 Nov;61(6):455-461.
Background The presence ofpulmonary arterial hypertension (PAH) in pregnant women increases mortality up to 12- 30% and up to 50% when PAH is associated with Eisenmenger syndrome. Due to low prevalence of PAH in pregnancy many aspects ofperioperative management are still unclear.
To summarize our approaches to the anesthesia and intensive care in pregnant women with PAH.
21 pregnant women with PAH (systolic pulmonary artery pressure (SPAP) higher than 60 mm Hg)-who underwent delivery by Caesarean section in 2010 - 2015 were included in the one-centre retrospective study. Data are presented as median (25th, 75th percentile).
The median age was 27 (23; 29) years. Among the patients, there were 4 (19%) cases of idiopathic PAH and in 17 (81%) women PAH was associated with congenital heart disease (CHD); 12 (57%) patients'demonstrated Eisenmenger syndrome. Baseline SPAP was 90 (82; 103) mm Hg. SpO2 90 (85,95)%. All women taken PAH-specific therapy (sildenafil) before delivery. Caesarean section (CS) were performed at 32 (28; 34) weeks. In 20 cases CS was perfofined under epidural anesthesia and in one case under general anesthesia due thrombocytopenia. Inhaled nitric oxide (NO) was administered intraoperative to all women in a dose of 40-60 ppm. Postoperative period was uncomplicated in five women (23?8%). Decompensation with PAP rise, acute right ventricular failure and hypoxemia developed in 16 (76,2%) cases 30 (24, 40) h after abdominal delivery. These patients required combined PAH-specific therapy (NO, sldenafil, iloprost) and inotropic agents, additionallyrespiratory support was used in four patients. The median ICU stay was 13 (9; 22) days. 3 patients died (14?2%); mortality in Eisenmenger syndrome cases was 25% (3/12). 18 healthy babies.
背景 孕妇患肺动脉高压（PAH）会使死亡率增加至12% - 30%，若PAH合并艾森曼格综合征，死亡率则高达50%。由于孕期PAH患病率较低，围手术期管理的许多方面仍不明确。
总结我们对患PAH孕妇的麻醉和重症监护方法。
纳入2010 - 2015年在一家中心行剖宫产分娩的21例患PAH（收缩期肺动脉压（SPAP）高于60 mmHg）的孕妇进行单中心回顾性研究。数据以中位数（第25、75百分位数）表示。
中位年龄为27（23；29）岁。患者中，4例（19%）为特发性PAH，17例（81%）女性的PAH与先天性心脏病（CHD）相关；12例（57%）患者表现为艾森曼格综合征。基线SPAP为90（82；103）mmHg。SpO2为90（85，95）%。所有女性在分娩前均接受了PAH特异性治疗（西地那非）。剖宫产在32（28；34）周进行。20例剖宫产在硬膜外麻醉下进行，1例因血小板减少在全身麻醉下进行。术中所有女性均吸入一氧化氮（NO），剂量为40 - 60 ppm。5例女性（23.8%）术后情况良好。16例（76.2%）在剖宫产后30（24，40）小时出现PAP升高、急性右心室衰竭和低氧血症导致的失代偿。这些患者需要联合PAH特异性治疗（NO、西地那非、伊洛前列素）和强心剂，4例患者还使用了呼吸支持。重症监护病房（ICU）中位住院时间为13（9；22）天。有3例患者死亡（14.2%）；艾森曼格综合征病例的死亡率为25%（3/12）。产下18名健康婴儿。
