妊娠期高血压疾病患者围术期并发症的预防及麻醉管理

摘要

目的:探讨妊娠期高血压疾病患者围术期并发症的预防及麻醉管理.方法:58例妊娠期高血压疾病施行剖宫产术的患者,术前对已有潜在危险的病例做好预防性治疗及对症处理.对已出现抽搐、昏迷、肺水肿、心衰的患者采取紧急有效的治疗、控制和抢救处理,术中严密观察和监控,积极维护心、脑、肺、肾等器官功能,维持血液动力学稳定.结果:本组58例患者,中度28例,重度30例.其中24例并发抽搐,血压升高;4例并发抽搐,收缩压≥160 mm Hg,舒张压≥110 mm Hg,经术前积极治疗和对症处理,病情稳定2 h后行剖宫产术;2例重度患者不仅出现抽搐、昏迷,且并发肺水肿、心衰,行静脉全麻插管后手术,迅速娩出胎儿的同时,作相应的对症处理和抢救措施,1例母婴平安度过危险期,15 d后治愈出院;另1例由于入院时病情过于严重,经抢救无效,母婴死亡,余56例均顺利完成手术,母婴健康.结论:积极做好术前准备,积极有效的麻醉管理是围术期并发症发生率下降和提高抢救治疗成功率的关键.%Objective:To investigate the prevention and anesthesia management of perioperative complications in patients with hypertensive disorders in pregnancy.Method:58 patients with hypertensive disorders in pregnancy were treated with cesarean section,and there were potential dangerous cases before operation.Preventive treatment and symptomatic treatment were done.To have convulsions,coma,pulmonary edema,heart failure patients took urgent and effective treatment,control and emergency treatment,postoperative close observation and monitoring,actively protect the heart,brain,lung,kidney and other organs function to maintain hemodynamic stability.Result:58 cases of this group,moderate in 28 cases,severe in 30 cases.The 24 cases complicated with convulsion,blood pressure.4 cases complicated with convulsion,systolic blood pressure greater than or equal to 160 mm Hg,diastolic blood pressure greater than or equal to 110 mm Hg,after preoperative treatment and symptomatic treatment,condition was stable within 2 h underwent cesarean section.2 cases of severe patients not only convulsions,coma,and pulmonary edema,heart failure,intravenous general anesthesia intubation was performed after surgery,rapid delivery of the fetus and,as appropriate symptomatic treatment and rescue measures,1 case of maternal and child safely through the dangerous period,15 d were cured and discharged from the hospital.Another example of the admission condition was too serious,after the rescue invalid,maternal deaths,more than 56 cases were successfully completed surgery,maternal and child health.Conclusion:Active and effective anesthesia management is the key to the incidence of perioperative complications and the key to improve the success rate of the treatment.