患有Fontan循环的患者剖宫产的管理：一例产后母体氧耗显著降低的病例报告
Management of cesarean section in a patient with Fontan circulation: a case report of dramatic reduction of maternal oxygen consumption after delivery.
作者信息
Saito Kazutomo, Toyama Hiroaki, Okamoto Atsushi, Yamauchi Masanori
机构信息
Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
出版信息
JA Clin Rep. 2020 Oct 4;6(1):77. doi: 10.1186/s40981-020-00385-w.
BACKGROUND
The anesthetic management of cesarean sections in Fontan-palliated parturients requires strict hemodynamic control. However, patient management with central venous oxygen saturation (ScvO) and oxygen consumption (VO) has never been reported.
CASE PRESENTATION
A 30-year-old woman, who had received a total cavopulmonary connection for tricuspid atresia, was planned to undergo cesarean section at 38 weeks' gestation. During combined spinal-epidural anesthesia, ScvO in addition to arterial pressure-based cardiac output (APCO) and central venous pressure (CVP) was monitored, and the change of VO was evaluated. After delivery, her APCO was almost unchanged. However, her ScvO increased dramatically from 42.1 to 67.3% and her CVP increased from 9 to 11 mm Hg. The calculated mean maternal VO changed from 443 to 295 mL/min.
CONCLUSIONS
In a cesarean section for a Fontan-palliated parturient, ScvO dramatically increased and maternal VO decreased by more than 25% after delivery.
背景
对于接受Fontan手术的产妇，剖宫产的麻醉管理需要严格控制血流动力学。然而，从未有过关于使用中心静脉血氧饱和度（ScvO）和氧耗量（VO）进行患者管理的报道。
病例介绍
一名30岁女性，因三尖瓣闭锁接受了全腔静脉肺动脉连接术，计划在妊娠38周时行剖宫产。在腰麻-硬膜外联合麻醉期间，除了监测基于动脉压的心输出量（APCO）和中心静脉压（CVP）外，还监测了ScvO，并评估了VO的变化。分娩后，她的APCO几乎没有变化。然而，她的ScvO从42.1%急剧增加到67.3%，CVP从9 mmHg增加到11 mmHg。计算得出的产妇平均VO从443 mL/min降至295 mL/min。
结论
在为接受Fontan手术的产妇进行剖宫产时，分娩后ScvO显著增加，产妇VO下降超过25%。
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