Pomini F, Mercogliano D, Cavalletti C, Caruso A, Pomini P
Department of Obstetrics and Gynecology, Università Cottolica del Sacro Cuore, Rome, Italy.
Ann Thorac Surg. 1996 Jan;61(1):259-68. doi: 10.1016/0003-4975(95)00818-7.
The cardiopathic patient can sustain acute heart failure during pregnancy. In such cases, if open heart operation is necessary to save the patient's life, the fetus could be seriously compromised after exposure to cardiopulmonary bypass. From 1958 to 1992, 69 reports of cardiac operations during pregnancy with the aid of cardiopulmonary bypass have been published. Maternal mortality was 2.9%. Embryofetal mortality was 20.2%. Examining only the last 40 patients, maternal and embryofetal mortality were 0.0% and 12.5%, respectively. Embryofetal mortality was 24.0% when hypothermia was used, compared with 0.0% while operating in normothermia. Maternal mortality did not change. The use of hypothermia during cardiopulmonary bypass provoked uterine contractions in several patients. Hypothermia decreases O2 exchange through the placenta. Pump flow and mean arterial pressure during cardiopulmonary bypass seem to be the most important parameters that influence fetal oxygenation. We speculate that cardiac operation is not a contraindication to pregnancy prolongation.
患有心脏病的患者在孕期可能会发生急性心力衰竭。在此类情况下，如果为挽救患者生命而必须进行心脏直视手术，胎儿在经历体外循环后可能会受到严重影响。从1958年至1992年，已有69篇关于孕期借助体外循环进行心脏手术的报告发表。孕产妇死亡率为2.9%。胚胎 - 胎儿死亡率为20.2%。仅研究最后40例患者，孕产妇死亡率和胚胎 - 胎儿死亡率分别为0.0%和12.5%。使用低温时胚胎 - 胎儿死亡率为24.0%，而在常温下手术时为0.0%。孕产妇死亡率未发生变化。体外循环期间使用低温在数例患者中引发了子宫收缩。低温会减少通过胎盘的氧气交换。体外循环期间的泵流量和平均动脉压似乎是影响胎儿氧合的最重要参数。我们推测心脏手术并非延长孕期的禁忌证。
