合併Eisenmenger氏症產婦之麻醉處理－－二病例報告

Anesthetic Management of Parturients with Eisenmenger's Syndrome-- Report of Two Cases

由於本身先天的心肺功能異常，Eisenmenger氏女性患者大多無法承受妊娠過程中生理的急遽變化，其母親的致死率和合併的胎兒罹病率均非常高。即使在今日，不論產科照顧和麻醉處理是如何長足進步，Eisenmenger氏症產婦的致死率仍高達25％。若Eisenmenger氏症產婦在妊娠過程中發生嚴重的肺高壓，終止懷孕仍是目前建議最好的處理方法。然而產婦本身的特殊生理變化，再合併此類先天心肺異常情況，都會讓麻醉醫師在處理過程中感到非常棘手且困難異常。在此我們提出兩個Eisenmenger氏症產婦合併嚴重肺高壓病症之病例，討論產科及麻醉處理其妊娠終止，其一為施行全身麻醉進行剖腹產，術後並併用體外膜性氧合循環機及一氧化氮吸入治療，終為死亡病例；另一為施行硬脊膜外腔麻醉進行經產道成功引產之病例。藉此病例報告以提出Eisenmenger氏症產婦之適合的產科及麻醉處理。

Pregnancy is badly tolerated in patients with Eisenmenger's syndrome; maternal mortality with coherent fetal morbidity is high. Even with the advancement of both obstetric and anesthetic managements, the maternal mortality still exceeds 25%. Once conception occurs in patients of Eisenmenger's syndrome with severe pulmonary hypertension, interruption of pregnancy is still the best manipulation to be recommended. We report two cases of parturients with Eisenmenger's syndrome, who underwent termination of pregnancy. In this report, the obstetric and anesthetic management of this kind of parturients with Eisenmenger's syndrome has been thoroughly discussed.