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腰麻下行瓦氏窦破裂产妇的急诊剖宫产:一例报告

Emergency Cesarean Section in a Parturient with Ruptured Sinus of Valsalva under Spinal Anesthesia: A Case Report.

作者信息

Cruz Mark Andrew B, Cruz Ma Concepcion L

机构信息

Department of Anesthesiology, College of Medicine and Philippine General Hospital, University of the Philippines Manila.

出版信息

Acta Med Philipp. 2024 May 23;58(9):59-64. doi: 10.47895/amp.v58i9.8746. eCollection 2024.

Abstract

Ruptured Sinus of Valsalva (RSOV) is a rarely encountered cardiac anomaly that can potentially lead to adverse clinical outcomes. RSOV increases the risk of morbidity during pregnancy due to the physiological changes associated with gestation, that can exacerbate the underlying cardiac pathology. We present the case of a 29-year-old female with an uncorrected RSOV who required an emergency cesarean section for abruptio placenta. The patient underwent the procedure under spinal anesthesia, with careful titration of norepinephrine infusion and close monitoring of hemodynamic parameters using an invasive intra-arterial line. Given the absence of established anesthetic protocols for parturients with RSOV undergoing cesarean delivery, a comprehensive understanding of the complex interaction between the hemodynamic effects of RSOV, pregnancy, and anesthesia is essential. This understanding enables the safe use of spinal anesthesia in urgent situations, leading to favorable patient outcomes.

摘要

瓦氏窦破裂(RSOV)是一种罕见的心脏异常,可能导致不良临床后果。由于妊娠相关的生理变化,RSOV会增加孕期发病风险,这些变化会加重潜在的心脏病理状况。我们报告一例29岁未矫正RSOV的女性病例,该患者因胎盘早剥需要紧急剖宫产。患者在脊髓麻醉下接受手术,谨慎滴定去甲肾上腺素输注量,并使用有创动脉导管密切监测血流动力学参数。鉴于目前尚无针对接受剖宫产的RSOV产妇的既定麻醉方案,全面了解RSOV、妊娠和麻醉的血流动力学效应之间的复杂相互作用至关重要。这种了解有助于在紧急情况下安全使用脊髓麻醉,从而使患者获得良好预后。

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本文引用的文献

1
Cardiac disease in pregnancy.妊娠与心脏疾病。
Best Pract Res Clin Anaesthesiol. 2022 May;36(1):191-208. doi: 10.1016/j.bpa.2022.02.005. Epub 2022 Feb 24.
7
Rare Presentation of a Ruptured Sinus of Valsalva Aneurysm.瓦氏窦瘤破裂的罕见表现
CASE (Phila). 2019 Nov 1;4(1):43-46. doi: 10.1016/j.case.2019.09.006. eCollection 2020 Feb.
9
Anesthesia for Urgent Cesarean Section.急诊剖宫产的麻醉。
Clin Perinatol. 2019 Dec;46(4):785-799. doi: 10.1016/j.clp.2019.08.010. Epub 2019 Aug 14.
10
Combined spinal-epidural versus spinal anaesthesia for caesarean section.剖宫产联合脊髓-硬膜外麻醉与脊髓麻醉的比较
Cochrane Database Syst Rev. 2019 Oct 10;10(10):CD008100. doi: 10.1002/14651858.CD008100.pub2.

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