摘要
目的探讨妊娠晚期合并急性脑梗死患者行急诊剖宫产术的麻醉管理的特点,为此类患者的临床麻醉管理提供参考。方法 2例妊娠晚期合并急性脑梗死患者行剖宫产术,经产科、神经内、外科、神经介入科及麻醉会诊,充分讨论后,以确保母婴安全为原则,依据产妇是否能够配合指令动作并实施指令,分别在硬膜外麻醉(病例1)和全凭静脉麻醉(病例2)下完成手术。结果母婴安全。病例1:术后神清,混合性失语。右侧中枢性面舌瘫,右上肢肌力3级,以上神经科查体同术前比较无变化,无神经功能恶化表现,下肢功能因麻醉作用未消失,无评估,病理征未引出。病例2:术后神经科查体配合欠佳。粗侧同术前:语清,左侧肢体肌力0级,右侧正常,双下肢病理征阳性。结论对于妊娠晚期合并急性脑梗死行急症剖宫产术的患者,需多学科多科室间的充分交流和通力合作,并注意术中的每一个细节,避免麻醉方法影响后续治疗及后续治疗引起麻醉并发症,以确保母婴的安全。此类患者的麻醉管理措施,宜实行个体化管理,着重注意维持术中血压稳定,避免因情绪激动及全麻管理不当导致的过度通气而进一步加重脑损伤。
Objective To explore the key points of anesthetic management for pregnant patients with acute cerebral infarction at late trim- esteeeer undergoing cesarean section and to contribute reference of anesthetic management for such patients. Methods Two patients with late tri-mester of pregnancy suffered of acute cerebral infarction undenvent emergent cesarean section, case 1 could pose at specific posture, she had performed epidural anesthesia, however, case 2 could not follow the instructions with dysphoria, she had given with total intravenous anesthesia. The multidisciplinaiy discussion including obstetrics, neurology and neurosurgeiy had been carried out, neuro - intenmention therapy department and an-esthesia department were cooperated before cesarean section. Results Parturients and infants were safe. Their neurological functions were similar to pre - operational ones in case 1 and case 2. Conclusion The multidisciplinaiy discussion is vital for pregnancy patients with acute cerebral infarction and the details to avoid interact side effects between anesthesia and the follow - up treatment are the key factors for success or fail and the key points of anesthetic management for such patients are avoiding to decrease blood pressure and hyperventilation.
出处
《临床和实验医学杂志》
2016年第19期1957-1960,共4页
Journal of Clinical and Experimental Medicine
关键词
妊娠
急性脑梗死
剖宫产
麻醉
Pregnancy
Acute cerebral infarction
Caesarean section
Anesthesia
