剖腹产后脊髓麻醉后心脏骤停:一个案例报告
Carolina Madruga1, Maria Inês Taborda1, Douglas Levier1
1Department of Anesthesiology, Unidade Local de Saúde de Amadora/Sintra, Amadora, PRT.
Cureus
|October 24, 2025
概括
孕妇脊柱麻醉可以触发贝佐尔德-贾里斯克反射,导致心脏骤停. 在产科紧急情况中,迅速识别和复苏对于母亲和胎儿的生存至关重要.
科学领域:
- 产科和妇科 产科和妇科
- 麻醉学 麻醉学
- 心脏病学 心脏病学
背景情况:
- 怀孕期间心脏骤停是一种罕见但至关重要的事件.
- 神经轴麻醉虽然在产科中很常见,但会带来心血管并发症的风险.
- 贝佐尔德-贾里斯克反射是脊髓麻醉后勃拉迪心脏和心血管静脉失速的潜在机制.
研究的目的:
- 报告怀孕期间在脊髓麻醉后心脏骤停的情况.
- 探索贝佐尔德-贾里斯克反射在这一事件中的作用.
- 强调在产科紧急情况中迅速管理的重要性.
主要方法:
- 一个39周怀孕的患者经历了紧急剖腹产的病例报告.
- 脊柱麻醉在有限的液体预加载下进行.
- 进行心肺复苏和新兴剖腹产分娩.
- 进行全面的诊断工作,以排除其他原因.
主要成果:
- 患者在脊髓麻醉后不久就出现了严重的低血压,心肌梗塞和心血管缩.
- 用上腺素和CPR实现自发循环的恢复.
- 在全身麻醉下成功的剖腹产.
- 患者完全康复,没有神经缺陷.
结论:
- 在这种情况下,Bezold-Jarisch反射是心脏骤停的可能原因.
- 降低预负载,可能是由于有限的液体复苏,可能有所贡献.
- 早期识别,适当的流体管理和多学科护理在产科麻醉中至关重要.
相关概念视频
Local Anesthetics: Clinical Application as Spinal Anesthesia
1.3K
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
1.3K
Local Anesthetics: Clinical Application as Epidural Anesthesia
685
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
685
Cardiopulmonary Resuscitation IV: Pharmacological Management
645
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
645
Cardiomyopathy VII: Pre and Post Operative Nursing Management
283
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
283
Cardiopulmonary Resuscitation III: AED Use
526
Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
526
Aneurysm IV: Nursing Management
372
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
372


