高民泰?曾庆诗

【摘要】妊娠合并心脏病患者通常需要介入性或者外科干预治疗改善孕妇的心功能，以往国内报道病例均为传统开胸心脏手术治疗。该文报道了国内首例妊娠中期全腔镜下二尖瓣机械瓣置换术体外循环建立及管理过程。该患者35岁，孕5产2，停经18+3周，因胸闷2个月，咳嗽1周入院，入院后经过检查及多学科会诊评估后行全腔镜下二尖瓣机械瓣置换术，术程顺利，围术期未见明显并发症，胎儿监测未见异常。该例提示，术前通过病情制定个体化的治疗方案，尽量选择理想的孕周开展外科手术，优化手术技巧及流程，在常规监测的同时持续监测胎心和宫缩以及凝血指标，选择常温或浅低温、高流量、搏动灌注等保护孕妇和胎儿的体外循环管理措施，尽量减少对胎儿和子宫的刺激，提高孕妇和胎儿围术期存活率，改善孕妇和胎儿的预后。

【关键词】全胸腔镜;心脏手术;体外循环;妊娠

Cardiopulmonary bypass management of totally thoracoscopic mechanical mitral valve replacement during the second trimester of pregnancy： the first case report in China Gao Mintai， Zeng Qingshi. Department of Cardial Surgery， Guangdong Academy of Medical Sciences， Guangdong Provincial Peoples Hospital， Guangdong Cardiovascular Institute， Guangzhou 510080， China

Corresponding author， Zeng Qingshi， E-mail： 1963088488@ qq. com

【Abstract】Pregnant women with heart diseases are primarily required to receive interventional therapy or surgical intervention to improve cardiac function. In China， conventional open heart surgery has been employed to treat such conditions in previous studies. In this article， the first case undergoing cardiopulmonary bypass with mechanical mitral valve replacement under total thoracoscopy in the second trimester in China was reported. The 35-year-old patient （G5P2） was admitted to the hospital due to “chest tightness for 2 months and cough for 1 week” at the 18+3 gestational weeks. After examination and multi-disciplinary consultation， she successfully underwent mechanical mitral valve replacement under total endoscopy. No evident complications were observed during perioperative period. No abnormality was detected in the fetus. This case hints that individualized treatment should be determined according to the severity of disease. The surgery should be performed at an appropriate gestational week. Surgical techniques and procedures need to be optimized. On the basis of routine monitoring， fetal heart rate， uterine contraction and coagulation parameters should also be dynamically monitored. Room temperature， mild low temperature， high flow rate and pulsation perfusion should be adopted to protect the cardiopulmonary bypass management of both pregnant woman and fetus， aiming to minimize the stimulation to the fetus and uterine， enhance the survival rate during perioperative period and improve the clinical prognosis of mother and fetus.

【Key words】Total thoracoscope;Cardiac surgery;Extracorporeal circulation;Pregnancy

隨着外科及体外循环技术的不断提高进步，妊娠期体外循环下心脏手术是安全可行的，妊娠中期心脏手术后继续妊娠的可能性也越来越大。目前该类病例报道较少，本文总结了我院收治的国内首例妊娠中期全腔镜下二尖瓣机械瓣置换术体外循环的建立以及管理过程，以供临床同道参考。

病例资料

一、主诉、现病史及体格检查

患者女，35岁，60 kg。因停经18+3周，胸闷2个月，咳嗽1周于2019年1月27日入院。患者2个月前出现上楼胸闷、气促，平地可行走半小时以上，无头晕，无心慌、心悸等不适，夜间可平卧入睡。……