晚期妊娠合并心力衰竭患者剖宫产的麻醉选择

目的探讨晚期妊娠合并心力衰竭患者剖宫产的麻醉选择。方法52例晚期妊娠合并心力衰竭患者根据麻醉方法不同分为3组。Ⅰ组18例,采用腰硬联合麻醉;Ⅱ组20例,采用硬膜外麻醉;Ⅲ组14例,采用局部麻醉。观察患者围手术期心力衰竭症状的改善、产后5min新生儿Apgar评分,羊水混浊度及新生儿预后、产妇产后出血等情况。结果Ⅰ、Ⅱ组产妇麻醉后心力衰竭症状改善、呼吸循环功能渐趋稳定,麻醉后循环呼吸功能各观察指标情况均优于Ⅲ组（P〈0.05或P〈0.01）。患者术中平稳,产后5min新生儿Apgar评分8～10分;Ⅱ组产妇2例在胎儿娩出后出现急性肺水肿,5例产后5min新生儿Apgar评分低于3分,需气管插管辅助呼吸,其中2例新生儿死亡。Ⅲ组羊水混浊度、产后出血均多于Ⅰ、Ⅱ组。结论腰硬联合麻醉、硬膜外麻醉均适宜于晚期妊娠合并心力衰竭患者。

The anesthesia choice of the patients combined late pregnancy with cardiac failure

Objective To discuss the anesthesia choice of caesarean section patients combined pregnancy with cardiac failure.Methods 52 cases of patients who were combined pregnancy with cardiac failure were divided into 3 groups by different anesthesia.Group I of 18 cases by CSEA;groupⅡ of 20 cases by EA and groupⅢ of 18 cases by RA.observed the variations of the syndrome in the patients during the operation,the Apgar score of the neonatals labored after 5 minutes,the condition of amniotic fluid and neonatals as well as the postpartum hemorrhage.Results after anesthesia,the patients of groupⅠand groupⅡ,the syndrome of the CHF were improved,the patients＇s function of the breath and circulation became better gradually and the palients were all silent during the operation,and the indicators of circulation and respirtory function of the two groups were better than those of group Ⅲ（P〈0.05 or P〈0.01）.The Apgar score of the neonatals were 8～10;but the groupⅢ,two cases about acute pulmary edema after labor,5 cases Apgar score were under 3 and they were necessary for intubation and assitant respiration,but two of them died.The groupⅢ was worse than groupⅠand groupⅡin both the condition of the amniotic fluid and the postpartum hemorrhage as well.Conclusion CSEA and EA are used safely and effectively to the patients combined late pregnancy with cardial failure.