Lertkovit Saranya, Nivatpumin Patchareya
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Anesth Pain Med (Seoul). 2022 Jul;17(3):291-297. doi: 10.17085/apm.21123. Epub 2022 Apr 19.
Pulmonary hypertension in pregnancy is rare and leads to high maternal morbidity and mortality.
A 27-year-old parturient woman with a 31-week gestational age underwent cesarean delivery under combined spinal-epidural anesthesia. She had systemic lupus erythematosus associated with severe pulmonary arterial hypertension. The operation was done in the cardiac theatre along with meticulous invasive monitoring. Insertion of femoral artery and femoral vein catheters for veno-arterial extracorporeal membrane oxygenation was done before delivery as preparation for the potential emergency of a life-threatening form of decompensated cardiac failure. During the delivery, the patient suddenly developed increased pulmonary arterial pressure. This was controlled by the continuous infusion of intravenous milrinone.
We report the successful management of this patient in the perioperative period. For cases such as that reported here, we recommend multidisciplinary team collaboration coupled with invasive cardiovascular monitoring and scrupulous anesthetic management.
妊娠期肺动脉高压罕见，会导致孕产妇高发病率和死亡率。
一名孕31周的27岁产妇在腰麻-硬膜外联合麻醉下接受剖宫产。她患有系统性红斑狼疮并伴有严重肺动脉高压。手术在心脏手术室进行，并进行了细致的有创监测。在分娩前插入股动脉和股静脉导管用于静脉-动脉体外膜肺氧合，作为应对失代偿性心力衰竭潜在危及生命紧急情况的准备。分娩过程中，患者肺动脉压突然升高。通过持续静脉输注米力农进行控制。
我们报告了该患者围手术期的成功管理。对于本文报道的此类病例，我们建议多学科团队协作，同时进行有创心血管监测和严格的麻醉管理。
