从三位同时接受剖腹产手术和心脏瓣膜手术的患者身上汲取的经验教训:麻醉师的观点

Alpin Tamay Fi̇nci̇, Nevin Aydin
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摘要

背景:心脏瓣膜病是妊娠期的一项挑战。在此,我们介绍了同时接受剖腹产和心脏瓣膜手术的三名患者的经验。本病例系列旨在概述同时接受心脏瓣膜手术和剖腹产手术的患者的临床特征,并强调手术/麻醉方面应注意的隐患。方法:该回顾性病例系列是从我们三级医疗中心妇产科和心血管外科接受心脏瓣膜手术和剖腹产手术的三名患者的病历中提取的数据。记录了人口统计学数据、病史、超声心动图检查结果、手术和麻醉技术以及围手术期信息和治疗结果:结果:三名平均年龄为 33.67 岁的孕妇在怀孕三个月时被诊断出患有各种心脏瓣膜病变。由于她们的心脏储备功能减退,且有明确的剖腹产指征,因此在剖腹产后接受了心脏瓣膜手术。所有患者的手术均顺利完成,产妇和婴儿在重症监护室接受随访后出院:我们建议,在某些情况下,可以在剖宫产术后同时进行心脏瓣膜手术。在决定是否绝对有必要进行有创手术之前,必须对风险和益处进行充分分析。各学科之间的密切合作、设备齐全的转诊中心、训练有素的人员以及对可能出现的并发症的进一步认识,是成功对患有心脏瓣膜病的孕妇进行手术治疗的关键点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective
Background: Cardiac valvular disease constitutes a challenge during pregnancy. Herein, we present our experience with three patients who underwent caesarean section and cardiac valvular surgery simultaneously. The purpose of this case series was to outline the clinical characteristics and to highlight the surgical/anesthesiologic pitfalls to be considered in patients who will undergo cardiac valvular surgery and caesarean section simultaneously. Methods: This retrospective case series was implemented using data extracted from the medical files of three patients who underwent cardiac valvular surgery and caesarean section in the obstetrics and gynecology and cardiovascular surgery departments of our tertiary care center. Demographic data, history, echocardiographic findings, surgical and anesthesiologic techniques as well as perioperative information and therapeutic outcomes were recorded. Results: Three pregnant women with an average age of 33.67 years were diagnosed with various cardiac valvular pathologies on the 3rd trimester. Owing to their diminished cardiac reserves and clear indications for cesarean section, the patients underwent cardiac valvular surgery subsequent to the cesarean section. Procedures were completed successfully on all patients and mothers and infants were discharged after a maternal follow-up in intensive care unit. Conclusion: We suggest that cardiac valve surgery can be performed simultaneously just after cesarean section in selected cases. Risks and benefits must be analyzed well prior to the decision making for the absolute necessity of the invasive procedure. Close collaboration between disciplines, well equipped referral centers, trained personnel and increased awareness on possible complications are the key points for successful surgical management of pregnant women with cardiac valve disease.
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