目的：探讨妊娠合并肺动脉高压患者急诊剖宫产手术的麻醉管理经验。方法：回顾性分析40例妊娠合并肺动脉高压患者急诊行剖宫产手术的临床资料，探讨术中麻醉管理措施，术后治疗。结果：30例患者采用椎管内麻醉，术后返回病房；10例患者采用全身麻醉，术后进入 ICU 进一步治疗。所有患者麻醉效果满意，麻醉期间血流动力学稳定。其中2例合并心衰患者术后在ICU 死于顽固性心衰、重度肺动脉高压及肾功能衰竭，其余患者经治疗后均在术后4～7d 顺利拔管返回病房。1例新生儿家属放弃治疗死亡。结论：椎管内麻醉可应用于妊娠合并轻、中度肺动脉高压患者剖宫产手术，对于心功能Ⅲ～Ⅳ级合并重度肺动脉高压的患者应选用全身麻醉。术中合理用药，维持血流动力学平稳，术后 ICU 的进一步治疗是保障孕妇安全度过围生期的关键。%Objective :To explore the anesthesia management of Caesarean section for pregnant women with pulmonary hypertension(PH) .Methods :Clinical data ,anesthesia management and postoperative treatment of 40 cases of pregnant women with pulmonary hypertension were analyzed retrospectively .Results :40 patients had a cesarean section ,30 patients with intraspinal anesthesia returned to the wards safely ,10 patients with general anes‐thesia went to ICU for further treatment .During the anesthesia ,hemodynamic was stable .2 patients died for re‐fractory heart failure ,severe PH and renal failure in ICU ,the rest were extubation during 4 to 7 days after the oper‐ation .1 premature was abandoned .Conclusion :Intraspinal anesthesia apply to the pregnant women with mild PH and moderate PH ,for patients with severe PH and heart function at level Ⅲ ‐ Ⅳ ,It is best to choose general anesthe‐sia .To use cardiovascular drugs rationally during surgery ,maintain hemodynamic stability and further treatment in ICU ,these are the important measure for pregnant women .
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