ANESTHESIA FOR CESAREAN SECTION WITH ACUTE PULMONARY EDEMA

剖腹生產併有急性肺水腫之麻醉

許汝寧(Yu-Ling Hui) ； 胡玉旺(Yuk-Wong Wu) ； 朱僑光(Kiu-Kwong Chu)

《Acta Anaesthesiologica Sinica》 28卷3期 (1990/09) Pp. 383-386

摘要

Anesthesia for cesarean section depends on the reason for operation, the degree of urgency, the desires of the patient, and the ability of anesthesiologist. No one method of anesthesia is ideal for cesarean section. The anesthesiologist must choose the method that he believes is safest and most comfortable for the mother and least depressant to the newborn and that provides the optimal working conditions for the obstet-rican. Utero-inhibitory agents are often given to the mother of preterm labor immediately before the administration of anesthesia. Currently, the most widely used group of drugs are the beta sympathomimetics. These include isoxsuprine, terbutaline and ritodrine Many of the effects of these drugs may persist even after discontinuation of therapy and may adversely interact with anesthetic agents. Significant maternal hemodynamic side effects include tachycardia, cardiac dysrhythmias, hypertension due to decrease peripheral vascular resistance, increased cardiac output, and occasionally pulmonary edema. Here we report a case used betamimetics to arrest premature uterine contraction and corticosteroid to enhance fetal lung maturity devloped acute pulmonary edema for cesarean section.

並列摘要

在婦產科臨床上普遍使用Betamimetie藥物來抑制子宮收縮和Corticosteroid來刺激胎兒肺兒肺部成熟。母親肺水腫是兩種藥物合併治療引起少見但嚴重之併發症。本病例是一位23歲的已婚婦女，懷孕34週，因早產住院安胎，臨床使用Ritodrine和Dexamethasone合併安胎療法，懷孕35週時，因收縮不適且胎向不正，於是安排剖腹生產。手術當天清晨全速灌注600ml林格氏液之後，病人逐漸呼吸短促，發紺，並咳出粉紅色泡沫狀痰液。胸部X光發現兩側肺水腫。緊急剖腹生產娩出一個健康的女嬰。麻醉是採用全身麻醉。以Thiopental使病人入睡，輔以Suecinycholine來幫助插入氣管內管。在嬰兒娩出後使用嗎啡來維持麻醉。用Suecinycholine滴點法來控制呼服，使呼吸次數為15/min，潮氣量為600cc同時也給予利尿劑Lasix 1 amp。整個手術過程失血及羊水800ml，尿量為700ml而祇給予400ml液體。病人在術後三天胸部X光已無腫水腫一週後便完全康復出院。病人在產後馬上做2D和M-mode心臟超音波檢查發現左心房輕微擴大，心室功能良好Swan-Gany心導管顯示右心房和心室，肺動脈和肺微血管楔狀壓力均正常。肺水腫之發生可能是因為Beta mimetic藥物停藥後引起alpha反彈刺激作用而引起血管收縮，此時再面臨水份負荷過多而發生肺水腫。