Please wait a minute...
浙江大学学报（医学版）
浙江大学学报（医学版）  2020, Vol. 49 Issue (2): 249-252    DOI: 10.3785/j.issn.1008-9292.2020.03.04
原著     
一例妊娠合并2019冠状病毒病(COVID-19)患者的剖宫产麻醉管理
康仙慧(),张荣,何慧梁,姚永兴,郑跃英,温小红*(),祝胜美*()
浙江大学医学院附属第一医院麻醉科, 浙江 杭州 310003
Anesthesia management in cesarean section for patient with COVID-19: a case report
KANG Xianhui(),ZHANG Rong,HE Huiliang,YAO Yongxing,ZHENG Yueying,WEN Xiaohong*(),ZHU Shengmei*()
Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
 全文: PDF(1025 KB)   HTML( 94 )
摘要：

2019冠状病毒病（COVID-19）会影响妊娠妇女的心肺功能，其剖宫产术的麻醉管理和医护人员防护与普通手术显著不同。2020年2月8日浙江大学医学院附属第一医院成功实施一例妊娠合并COVID-19患者剖宫产手术，本文介绍围术期麻醉管理、医护人员防护和产妇心理干预等经验。应重视妊娠合并COVID-19患者术前评估和麻醉计划实施，COVID-19普通型患者剖宫产首选椎管内麻醉，注意减少对母婴呼吸循环的影响；重型和危重型患者应选择气管插管全身麻醉。加强医疗环境安全，麻醉医生应尽量采取三级标准防护。对于产妇心理应予特殊关注：术前加强解释说明减轻产妇焦虑；术中减轻产妇不适，缓解紧张情绪；术后避免产妇因疼痛而产生不良的情绪。
关键词： 2019冠状病毒病;  严重急性呼吸综合征冠状病毒2;  新型冠状病毒肺炎;  剖宫产术;  麻醉, 硬膜外;  病例报告    
Abstract:

Since the coronavirus disease 2019 (COVID-19) affects the cardio-pulmonary function of pregnant women, the anesthetic management and protection of medical staff in the cesarean section is significantly different from that in ordinary surgical operation. This paper reports a case of cesarean section for a woman with COVID-19, which was successfully performed in the First Affiliated Hospital of Zhejiang University School of Medicine on February 8, 2020. Anesthetic management, protection of medical staff and psychological intervention for the pregnant woman during the operation were discussed. Importance has been attached to the preoperative evaluation of pregnant women with COVID-19 and the implementation of anesthesia plan. For moderate patients, intraspinal anesthesia is preferred in cesarean section, and try to reduce its influence in respiration and circulation in both maternal and infant; general anesthesia with endotracheal intubation should be adopted for severe or critically ill patients. Ensure the safety of medical environment, and anesthetists should carry out level-Ⅲ standard protection. Special attention and support should be paid to maternal psychology: fully explanation before operation to reduce anxiety; relieve the discomfort during operation, so as to reduce tension; avoid the bad mood due to pain after operation.
Key words: Coronavirus disease 2019    Severe acute respiratory syndrome coronavirus 2    Novel coronavirus pneumonia    Cesarean section    Anesthesia, epidural    Case reports
收稿日期: 2020-02-29 出版日期: 2020-03-11
:  R614  
基金资助: 浙江大学“十三五”第一批教学改革研究项目(zdjg08077, zdjg08081)
通讯作者: 温小红,祝胜美     E-mail: kxhui66@zju.edu.cn;0087420@zju.edu.cn;smzhu20088@zju.edu.cn
作者简介: 康仙慧(1979-), 女, 博士, 副主任医师, 主要从事麻醉和疼痛的临床及基础研究; E-mail:kxhui66@zju.edu.cn; https://orcid.org/0000-0002-3132-3369
服务　　
把本文推荐给朋友
加入引用管理器
E-mail Alert
RSS
作者相关文章　　
康仙慧
张荣
何慧梁
姚永兴
郑跃英
温小红
祝胜美

引用本文:

康仙慧,张荣,何慧梁,姚永兴,郑跃英,温小红,祝胜美. 一例妊娠合并2019冠状病毒病(COVID-19)患者的剖宫产麻醉管理[J]. 浙江大学学报（医学版）, 2020, 49(2): 249-252.

KANG Xianhui,ZHANG Rong,HE Huiliang,YAO Yongxing,ZHENG Yueying,WEN Xiaohong,ZHU Shengmei. Anesthesia management in cesarean section for patient with COVID-19: a case report. J Zhejiang Univ (Med Sci), 2020, 49(2): 249-252.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2020.03.04    或    http://www.zjujournals.com/med/CN/Y2020/V49/I2/249

1 CHEN H J , GUO J J , WANG C et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records[J]. Lancet, 2020,
doi: 10.1016/S0140-6736(20)30360-3
2 周志强, 孙星星, 李世勇 et al. 新型冠状病毒肺炎流行期间剖宫产术的麻醉管理[J]. 中华麻醉学杂志, 2020, 40
ZHOU Zhiqiang , SUN Xingxing , LI Shiyong et al. Anesthesia management for cesarean section during novel coronavirous epidemic[J]. Chinese Journal of Anesthesiology, 2020, 40
doi: 10.3760/cma.j.issn.0254-1416.2020.0006
3 WU Z , MCGOOGAN J M . Characteristics of and important lessons from the coronavirus disease 2019(COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention[J]. JAMA, 2020,
doi: 10.1001/jama.2020.2648
4 薄禄龙, 万小健, 卞金俊 . 新型冠状病毒肺炎患者实施气管插管术的感控建议:基于SARS患者气道管理的文献回顾[J]. 中华麻醉学杂志, 2020, 40
BO Lulong , WAN Xiaojian , BIAN Jinjun . Suggestions on infection control for performing endotracheal intubation in patients with novel coronavirus pneumonia: based on literature review of airway management in patients with SARS[J]. Chinese Journal of Anesthesiology, 2020, 40
doi: 10.3760/cma.j.issn.0254-1416.2020.0002
5 中华医学会麻醉学分会气道管理学组 . 新型冠状病毒肺炎危重型患者气管插管术的专家建议(1.0版)[J]. 中华麻醉学杂志, 2020, 40
Chinese Society of Anesthesiology Task Force on Airway Management . Expert recommendations for tracheal intubation in critically ill patients with novel coronavirus pneumonia (version 1.0)[J]. Chinese Journal of Anesthesiology, 2020, 40
doi: 10.3760/cma.j.issn.0254-1416.2020.02.003
6 KAMMING D , GARDAM M , CHUNG F . Anaesthesia and SARS[J]. Br J Anaesth, 2003, 90 (6): 715- 718
doi: 10.1093/bja/aeg173
7 熊利泽 . 抗击新型冠状病毒肺炎疫情:给麻醉科医护工作者的几点建议[J]. 中华麻醉学杂志, 2020, 40 (2): 129
XIONG Lize . Fight against novel coronavirus pneumonia: suggestions for medical staff in anesthesiology department[J]. Chinese Journal of Anesthesiology, 2020, 40 (2): 129
doi: 10.3760/cma.j.issn.0254-1416.2020.0001
8 中国医师协会新生儿科医师分会, 中国富有保健协会新生儿保健专业委员会, 《中华围产医学杂志》编辑委员会 et al. 新生儿科2019新型冠状病毒感染防控专家建议[J]. 中华围产医学杂志, 2020, 23 (2): 80- 84
Chinese Neonatologist Association , Chinese Medical Doctor Association , Neonatal Health Association et al. Proposed prevention and control of 2019 novel coronavirus infection in neonates[J]. Chinese Journal of Perinatal Medicine, 2020, 23 (2): 80- 84
doi: 10.3760/cma.j.issn.1007-9408.2020.02.002
9 马宁, 马弘, 李凌江 . 《新型冠状病毒肺炎疫情紧急心理危机干预指导原则》专家解析[J]. 中华精神科杂志, 2020, 53
MA Ning , MA Hong , LI Lingjiang . Reading and analysis of the guiding principles of emergent psychological crisis intervention in the novel coronavirusd pneumonia[J]. Chinese Journal of Psychiatry, 2020, 53
doi: 10.3760/cma.j.issn.1006-7884.2020.0001
10 中国医师协会妇产科医师分会母胎医师专业委员会, 中华医学会妇产科分会产科学组, 中华医学会围产医学分会 et al. 妊娠期与产褥期新型冠状病毒感染专家建议[J]. 中华围产医学杂志, 2020, 23 (2): 73- 79
Maternal and Fetal Experts Committee , Chinese Physician Society of Obstetrics and Gynecology , Chinese Medical Doctor Association et al. Proposed management of 2019-novel coronavirus infection during pregnancy and puerperium[J]. Chinese Journal of Perinatal Medicine, 2020, 23 (2): 73- 79
doi: 10.3760/cma.j.issn.1007-9408.2020.02.001
[1] 王锦程,刘锦鹏,王园园,刘伟,陈小群,孙超,沈晓勇,汪启东,吴亚平,梁文杰,阮凌翔. 2019冠状病毒病(COVID-19)患者胸部CT影像学动态变化[J]. 浙江大学学报（医学版）, 2020, 49(2): 191-197.
[2] 张小燕, 孙伟, 尚世强, 毛建华, 傅君芬, 舒强, 江克文. 2019冠状病毒病(COVID-19)疫情期生物样本保藏生物安全防护原则及建议[J]. 浙江大学学报（医学版）, 2020, 49(2): 170-177.
[3] 曹盛力,冯沛华,时朋朋. 修正SEIR传染病动力学模型应用于湖北省2019冠状病毒病(COVID-19)疫情预测和评估[J]. 浙江大学学报（医学版）, 2020, 49(2): 178-184.
[4] 陈军,刘丹萍,刘莉,刘萍,徐庆年,夏露,凌云,黄丹,宋树丽,张丹丹,钱志平,李涛,沈银忠,卢洪洲. 硫酸羟氯喹治疗2019冠状病毒病(COVID-19)普通型患者的初步研究[J]. 浙江大学学报（医学版）, 2020, 49(2): 215-219.
[5] 陈志敏,傅君芬,舒强,汪伟,陈英虎,华春珍,李甫棒,林茹,唐兰芳,汪天林,王颖硕,徐玮泽,杨子浩,叶盛,袁天明,张晨美,张园园. 儿童2019冠状病毒病(COVID-19)诊疗指南(第二版)[J]. 浙江大学学报（医学版）, 2020, 49(2): 139-146.
[6] 徐凯进,蔡洪流,沈毅弘,倪勤,陈瑜,胡少华,李剑平,王华芬,俞亮,黄河,裘云庆,魏国庆,方强,周建英,盛吉芳,梁廷波,李兰娟. 2019冠状病毒病(COVID-19)诊疗浙江经验[J]. 浙江大学学报（医学版）, 2020, 49(2): 147-157.
[7] 姜赛平,李璐,茹仁萍,张春红,饶跃峰,林彬,王融溶,陈娜,王小娟,蔡洪流,盛吉芳,周建英,卢晓阳,裘云庆. 2019冠状病毒病(COVID-19)重型、危重型患者用药管理经验[J]. 浙江大学学报（医学版）, 2020, 49(2): 158-169.
[8] 李鑫,代甜,王虹,石军年,袁薇,栗静,陈利军,张天明,张珊珊,孔焱,岳宁,时慧,何玉苹,胡惠芳,柳芙蓉,杨彩霞. 2019冠状病毒病(COVID-19)疑似患者合并焦虑和抑郁的临床分析[J]. 浙江大学学报（医学版）, 2020, 49(2): 203-208.
[9] 骆嵩,杨丽娟,王春,刘传苗,李殿明. 血浆置换和托珠单抗治疗六例2019冠状病毒病(COVID-19)重型患者临床分析[J]. 浙江大学学报（医学版）, 2020, 49(2): 227-231.
[10] 洪东升,倪剑,单文雅,李璐,胡希,羊红玉,赵青威,张幸国. 基于监测数据的药物不良反应快速识别及R语言实现[J]. 浙江大学学报（医学版）, 2020, 49(2): 253-259.
[11] 钟琦,李志,沈晓勇,徐凯进,沈毅弘,方强,陈峰,梁廷波. 2019冠状病毒病(COVID-19)不同临床分型患者胸部CT影像学特征[J]. 浙江大学学报（医学版）, 2020, 49(2): 198-202.
[12] 陈旭,李央,王金希,蔡洪流,曹红翠,盛吉芳. 三例妊娠合并2019冠状病毒病(COVID-19)患者诊治分析[J]. 浙江大学学报（医学版）, 2020, 49(2): 240-244.
[13] 沈利华,黄菲,陈祥,熊钻,杨晓玉,李慧,程丰,郭健,龚国富. 严重急性呼吸综合征冠状病毒2(SARS-CoV-2)核酸检测试剂盒临床诊断效能评估[J]. 浙江大学学报（医学版）, 2020, 49(2): 185-190.
[14] 张胜,李丹萍,陈华忠,郑丹,周益萍,陈葆国,石卫武,林荣海. 糖皮质激素治疗一例2019冠状病毒病(COVID-19)危重型患者炎症反应动态观察[J]. 浙江大学学报（医学版）, 2020, 49(2): 220-226.
[15] 李游江,胡瑛瑛,张晓东,喻员员,李斌,吴建国,吴英萍,夏肖萍,徐键. 七例2019冠状病毒病(COVID-19)普通型患者出院后病毒核酸随访结果[J]. 浙江大学学报（医学版）, 2020, 49(2): 270-274.