助力肥胖症孕妈妈顺利升级

近日，医院产科

成功帮助一位心功能III级，肥胖症的孕妈妈

顺利升级，圆了她的梦，可喜可贺！

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回首过去，是艰辛的

她，结婚6年。由于自身的基础体重肥胖最终没能顺利怀孕，她求子心切，途中几乎尝试过各种方法，结果每次都与天使宝宝擦肩而过。但她未曾气馁过，依然心存希望。这次她成功怀上却合并众多并发症，增加了分娩的风险性。

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病程摘要

入院：体重Kg，cm，孕38+3周，心功能III级，肥胖症，高脂血症，妊娠期糖尿病等。孕期血糖控制不理想，自诉近一个多月夜间不能平睡，需要垫高枕头才可睡觉，平地走路困难，但无心慌心悸，胸闷气促等不适。经过产科主任罗绮薇，麻醉科主任戴载深，儿科主任等多学科共同商讨后，决定次日行剖宫产术。

当天早上，医务人员早早已在准备~~~

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椎管内“盲穿”成功！

协助她侧卧位，指导低头找自己的锁骨位置，双腿向腹部蜷缩，尽可能地向对侧弓腰，如同“C”字形，利于穿刺针在她的腰椎间隙进针。由于妊娠激素水平的变化和妊娠期硬膜外腔静脉曲张，椎管潜在的空间相对较小，再加上她背部有非常厚的脂肪组织，穿刺目标无法看到或摸到，全凭麻醉医生对解剖结构的了解和操作经验进行“盲穿”，最终我院麻醉医生还是成功了！接下来就开始手术~~

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仰卧位低血压综合征

仰卧位低血压综合征是指妊娠晚期孕妇仰卧位时，出现头晕、恶心、呕吐、胸闷、面色苍白、出冷汗、心跳加快及不同程度血压下降，当转为侧卧位后，上述症状即减轻或消失的一组综合征。严重者可危及母儿的生命。

大家协助她仰卧位于手术床上，突然出现仰卧位低血压综合征。台下的医务人员加快补液，调手术床的倾斜度，给予升压药等，产科主任罗绮薇医生和何芳医生立刻加快步伐，一心想迅速取出其腹中胎儿，缓解她的不适。“切开一刀是脂肪，再切一刀还是脂肪。”产科医生心头一紧一紧再一紧！好不容易开了腹，到达子宫浆膜层肌层。她的切口像安了弹簧一样，助手使劲牵拉这拉钩，格外吃力。再加上因呕吐腹压的增大导致肠子跑出术野，更难于暴露术野，增加的手术的难度及其风险。

“滴滴滴滴”快速的心跳声

听到心电监护机传来“滴滴滴滴”快速的心跳声，此时手术医生明白到她的仰卧位低血压症状加重了。手术医生心急如焚，但依旧冷静沉着有条不紊地一步一步做下去~~~台下的医务人员不断地配合台上的工作。

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婴儿娩出，症状缓解

“哇~哇~哇~”顺利娩出体重为4.58Kg胖乎乎的婴儿。仰卧位低血压症状消失，术中行了双侧子宫动脉结扎术+B-lynch缝合术等，预防产后出血。术中出血不多，生命体征平稳，最终安返ICU病房观察。

接下来我们最担心的是她的术后伤口愈合以及心功能恢复的情况

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略巧施妙计

她腹部切口皮下脂肪肥厚，术后易发生脂肪液化（脂肪液化是指伤口内的脂肪发生的坏死，导致脂肪转化成脓性的或脂肪性的液体积聚在伤口内，导致细菌在其中滋养繁殖，引起伤口的炎性反应，甚至造成伤口内脓肿的形成。对脂肪液化的发生常见于较为肥胖者。）导致伤口愈合不良，严重时会局部感染等增加她的痛苦和经济的负担。为了解决这问题手术医生决定术后，外缝并放置负压引流管等个性化处理。

产后3日内仍是心脏负担较重的时期。除子宫收缩使一部分血液进入体循环外，妊娠期组织间潴留的液体也开始回到体循环。妊娠期出现的一系列心血管变化，在产褥期尚不能立即恢复到妊娠期状态，应警惕心力衰竭的发生。幸运的是在ICU病房监护下，生命体征一切平稳。经过医务人员的悉心的护理，目前已成功出院了。

关于肥胖症您知道多少？

随着生活节奏的加快和工作压力的增大，很多人在增加膳食能量的摄入的同时减少体力活动，全球范围内肥胖人群比例显著增多。

世界卫生组织根据体重指数（Bodymassindex,BMI）计算公式为：BMI=体重÷身高2。（体重单位：千克；身高单位：米。）

把肥胖分成几个等级：

◎正常：18.9-24.9kg/m2

◎超重：25.0-29kg/m2

◎肥胖：≥30kg/m2。根据体重指数可以进一步分三级：

一级：30.0-34.9kg/m2

二级：35.0-39.9kg/m2

三级：≥40kg/m2

对于处于备孕状态的肥胖女性易发生不孕不育症，处于妊娠期肥胖导致母儿相关风险增加，如流产、妊娠期糖尿病、高血压、子痫前期、血栓栓塞性疾病，以及死产、巨大儿、肩难产、胎粪吸入等，所以育婚女性要重视肥胖症带来的危害。

番禺区医院运动营、分娩体验馆已推出各种孕期运动课程等，帮助孕妈妈控制体重的猛增，腰痛，盆底痛等，成功帮助了孕妈妈顺利分娩，欢迎各位孕妈妈前来体验！

上课地点：

运动营分娩体验馆

番禺区妇幼保健院沙湾产科院区1号楼一楼

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