Pregnancy combined mechanical valve acute dysfunction retains pregnancy re-valve anaesthetic in case

Pregnant women, 35 years old, 160 cm, 70 kg, pregnant 28 plus weeks, due to "stopped for 28 plus weeks, panic, chest tightness, wheezing 2d" hospital14 years ago due to rheumatic heart disease two-tip mechanical valve replacement, after surgery oral warfarin anticoagulant treatment, not regular monitoring of coagulation function, can carry out mild physical activityThis pregnancy, pregnancy 15 plus weeks without authorization to reduce the amount of warfarinEmergency admission, by chest echocardiogram examination: blood shot score 65%, two-tip valve artificial mechanical valve replacement surgery, artificial mechanical valve stenosis (about 0.5 cm2), mild increase in the left atrium, aortic valve reflux (mild), trilateral valve reflux (mild), pulmonary arterial hypertension (mild)Consider the artificial mechanical flapadmission the next day, in the retention of pregnancy general anesthesia downstream "two-tip valve mechanical valve replacement surgery and three-tip valve forming." Pregnant women into the room after the mask oxygen absorption, open the upper extremities peripheral 16G venous pathway, bureau hemp artery and foot artery puncture tube, continuous fetal heart monitoringAnesthetic induction: slow injection of midazolam 0.06 mg/kg, sub-static injection of 0.12mg/kg, roco brominated ammonium 0.9mg/kg, Shufentani 1.5ug/kg, the induction process is stableThe venous puncture tube in the right neckIntraoperative anaesthetic maintenance: propofol 0.3mg kg-1 min-1, Shufentani 0.01?g.kg-1.min-1, intermittent injection of ammonium monofol to maintain muscle pinecardiopulmonary transfer (CPB) method: 3mg/kg heparinization, CPB at room temperature, CPB time 104min, cardiomyosis blocking time 65min, 5.0 to 5.6L/min high-flow perfusionThe artificial mechanical flap ring was removed, and theblood clotsattachedThe open ascending aorta automatically re-jumps, gives epinephrine 0.05mg kg-1-min-1 assisted heart output, norepinephrine 0.03mg kg-1-min-1 increases peripheral cycle resistance and shuts down smoothlyIn the process of anesthesia, continuous fetal heart monitoring, in which the fetal heart natural deceleration, the slowest 80 times / minute, lasting about 10min, can be restoredDuring the operation, the suspended red blood cells 4U, plasma 400 ml, intraoperative infusion 750 ml, bleeding 1000 ml After surgery, return to ICU, BP 155/75mmHg, RR14 times/min, HR112 times/min, CVP 16mmHg, double lung breathing, pregnant women and fetal vital signs are stable the first day after the heart surgery, B super-
examination: intrauterine pregnancy, single stillbirth Active anti-
infection treatment, in the 2nd day after surgery, full hemp undersection caesarean section to get the fetus After surgery 6h patients are awake and the trachea intubation is removed The patient is discharged from the hospital on the 23rd day After 1 month the heart is functioning well discuss
thrombosis blocking mechanical valves is a rare complication Early resurgery is the only way to save a patient's life in pregnant women with acute mechanical valve dysfunction Relevant literature reported that during pregnancy, the retention of pregnancy in CPB-assisted surgical treatment, the maternal mortality rate is about 1.5% to 5.0%, but the fetal mortality rate is as high as 16% to 33%, and not related to pregnancy age Considering the particularity of maternal and fetal, the clinical how to choose the mode and timing of surgery to ensure the safety of mother and child is clinical treatment difficulties anaesthetic induction process is often the most obvious time of hemodynamic fluctuations, should be extra cautious, when necessary, the use of vascular active drugs to maintain hemodynamic stability, to ensure the supply of placental blood flow, the choice of anesthesia should be safe, simple and effective principle Artificial mechanical flap scarlet scarlet scarlet pregnant women, due to increased blood capacity during pregnancy, increased front load, and the two-tip valve significantly narrow, so that the output is limited, serious circulation conditions can collapse instantaneously, and even the occurrence of acute left heart failure depletion, pulmonary artery pressure increased sharply, tired of the right heart, etc., so the course of surgery, should be appropriate control of the ventricle rate In addition, the operation should strictly control the amount of liquid and infusion speed, so as to avoid congestive heart failure The choice of CPB strategy has a great impact on the safety of maternal and fetal life It has been reported that the use of room temperature CPB technology can significantly improve the survival rate of fetuses in surgery, low temperature CPB group fetal loss rate of 24% But the oxygen supply and demand of the important organs of the normal temperature CPB is a challenge for pregnant women, and high average arterial pressure can be maintained by shortening the time of surgery CPB, high blood flow and high oxygen flow perfusion The use of pulsating CPB perfusion during pregnancy can increase the release level of endothelial cells NO, inhibit uterine contraction, increase the supply of uterine and placental blood flow, and be beneficial to the protection of the fetus in addition, it is recommended to continue to use Doppler ultrasound monitoring, can be in the intrauterine placental perfusion in real-time assessment, timely detection and treatment of special cases during surgery, to ensure the safety of pregnant women and fetuses In time to do blood gas analysis and examination, to maintain the stability of the internal environmental acid-base electrolyte, especially K,Mg2 plus concentration, to avoid the occurrence of malignant arrhythmia The infusion of allogeneic blood can be reduced by using the -blood re-transfusion technology After the END of the CPB need to pay attention to the ACT test, not only to prevent postoperative wounds and placental blood seepage, but also to prevent the recurrence of blood clots blocking mechanical valves Studies have found that preventive antibiotics are effective in preventing infections in Keeping the heart surgery of pregnancy is more dangerous, choosing the appropriate surgical treatment method and timing, strengthening the perithetic anaesthetic management , will help the mother and child safety