Antepartum Diagnosis and Management of Idiopathic Pericardial and Pleural Effusion: Report of One Case

本病例在産前超音波即診斷爲心包膜積水合併左側肋膜積水(pericardial effusion with pleural effusion)並在超音波定位下實施心包膜穿刺術(pericardiocentesis)，胸腔穿刺術(thoracentesis)及羊膜穿刺術(amniocentesis)。實驗室檢查發現母親血型爲Rh陽性、沒有非典型抗體、梅毒及弓型蟲病抗體皆陰性。胎兒心包膜液分析葡萄糖含量71mm/dl，蛋白質含量3.7gm/dl，病毒和細菌培養皆無生長。經由部腹産生一位男嬰，體重3540公克，出生後及出現窒息及全身發紺現象，Apgar score 在1分鈡及5分鍾時分別3和4，病嬰經氣管插管及輔助呼吸處理後，情況穩定即轉入新生兒加護病房進一步治療。當胸部X光顯示左側肋膜積水後實施胸管引流，7天後引流液少而拔管。病人情況良好於第八天出院，此時病嬰仍有呼吸較快現象。出院後，從未至門診追蹤，在4個月後出現嚴重的呼吸困難症狀而至急診室求診。當時胸部X光顯示左側有復發的肋膜積水，再經胸管引流後，病嬰於第10天出院。在門診繼續追蹤8個月，沒有復發情形。本文報告此病例，乃是提供一種新方法，在産前檢查發現有心包膜積水或肋膜積水時，可以實施子宮內引流療法。同時在胎兒出生時，可以實施子宮內引流療法。同時在胎兒出生時，由婦産科和新生兒科專家組成一個治療小組，必可降低胎兒的死亡率。

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並列摘要

A case of an antenatal ultrasound diagnosis of pericardial effusion with pleural effusion is reported. Fetal pericardiocentesis, thoracentesis and amniocentesis were performed with real-time ultrasound guidance at 37 weeks of gestation. Laboratory investigations reported a rhesus-positive blood group, no atypical antibodies, negative serologic test for syphilis, and negative titers for toxoplasmosis. The laboratory data of the pericardial effusion showed: glucose 71 mg/dl, protein 3.7 gm/dl, LDH 73 U/L, CPK 53 U/L, negative culture for virus and bacteria. The pregnancy was terminated at 37 weeks of gestation by Cesarean section because of an edematously enlarged thorax. A 3540 gm male infant was delivered in a state of asphyxia with generally cyanosis and an Apgar score of 3 and 4 at one and was delivered in a state of asphyxia with general cyanosis and an Apgar score of 3 and 4 at one and five minutes, respectively. His condition improved after endotracheal intubation and assisted ventilation. He was transported to the neonate intensive care unit, where chest roentgenogram confirmed pleural effusion over the left side. Chest tube was placed for 7 days. The infant was discharged on day 8, but the fluid reaccumulation over the left lung four months later. Chest tube was placed for five days. The infant subsequently has thrived with appropriated development for his age. We report herein because of successful technique of antepartal intervention.

並列關鍵字

antepartal diagnosis ； ultrasound ； pericardial effusion ； pleural effusion ； pericardiocentesis ； thoracentesis

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Antepartum Diagnosis and Management of Idiopathic Pericardial and Pleural Effusion: Report of One Case

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