Sustained Preeclampsia into the Postpartum Period Complicated with Severe Pericardial Effusion: A Case Report

生產後持續的子癲前症合併嚴重心包膜積液：病例報告

蔡鎧任(Kai-Ren Tsai) ； 賴柏茵(Po-Yin Lai) ； 陳鋭溢(Jui-Yi Chen)

《內科學誌》 33卷3期 (2022/06) Pp. 233-240

https://doi.org/10.6314/JIMT.202206_33(3).07

摘要

In the natural course of preeclampsia, proteinuria usually begins to improve within a few days after delivery. In heavy proteinuria, complete resolution may take weeks to months. In this case, hypertension and proteinuria persisted for 3 months after delivery. In addition, an uncommon complication-pericardial effusion-also occurred. This 34-year-old woman delivered a baby two months ago, and she had type 2 diabetes mellitus for two years. During the second trimester, heavy proteinuria with hypertension was noted; therefore, preeclampsia was diagnosed. However, tachycardia with four-limbs edema persisted after delivery, and a large amount of pericardial effusion was detected by transthoracic echocardiography. The renal biopsy revealed diabetic nephropathy superimposed with glomerular injury of preeclampsia. Preeclampsia may be complicated by severe pericardial effusion and fluid overload, and its symptoms may persist after delivery. Glycemic and intensive blood pressure control could improve the urine protein/creatinine ratio.

關鍵字

Preeclampsia ； Postpartum ； Pericardial effusion

並列摘要

在子癲前症的自然病程中，蛋白尿的症狀通常於生產後的幾天內緩解，若是蛋白尿症狀很嚴重，則在幾周甚至幾個月後才能完全回復。而這位病患，在生產後除了持續性地長達三個月的高血壓及蛋白尿之外，更合併了少見的併發症—心包膜積液。這位34歲女性在兩個月前成功產下了一名嬰兒，過去她有糖尿病病史長達兩年。在妊娠第二期時，因為出現嚴重蛋白尿合併高血壓的症狀，所以被診斷為子癲前症，但在生產後，心搏過速以及四肢水腫的症狀仍然持續，而且經由心臟超音波檢查發現了大量的心包膜積液，最後，腎臟切片結果是糖尿病腎病變合併子癲前症造成的腎絲球損傷所導致。子癲前症的症狀有可能在生產後持續發生，也有可能合併嚴重地心包膜積液和體液過多等症狀，良好的血壓及血糖控制即可改善蛋白尿。