Acute Respiratory Failure in Two Pregnant Women during Tocolytic Treatment: Two Case Reports

安胎孕婦併發急性呼吸衰竭－兩例病例報告

朱聖棻(Sheng-Fen Chu) ； 郭秋萍(Chiu-Ping Kuo) ； 王玠仁(Chieh-Jen Wang) ； 吳健樑(Chien-Liang Wu)

《胸腔醫學》 23卷6期 (2008/12) Pp. 414-420

https://doi.org/10.29806/TM.200812.0003

摘要

安胎孕婦的肺水腫在懷孕婦人危症中佔約四分之一。其中如果合併急性呼吸窘迫症，死亡率更高達23%。造成肺水腫的原因分為心因性及非心因性，包括感染、安胎藥物、子癇前症、及體液過量。我們報告分別是因安胎藥物及感染合併急性呼吸窘迫症引發急性肺水腫及呼吸衰竭的孕婦，在侵入性呼吸器的支持下，以肺動脈導管指引給予升壓劑及利尿劑治療改善，最後脫離呼吸器並拔管成功的兩個病例。

關鍵字

安胎治療 ； 急性呼吸衰竭 ； 肺水腫 ； 急性呼吸窘迫症

並列摘要

Acute respiratory failure due to pulmonary complications or acute respiratory distress syndrome (ARDS) is a life-threatening condition during pregnancy. The incidence of pulmonary edema is 24% in all critical illnesses associated with pregnancy. The causes are numerous, having both cardiogenic and non-cardiogenic origins, and include sepsis, tocolytic agents, and preeclampsia. The mortality rate could be as high as 23% in patients with ARDS. We report 2 patients with acute pulmonary complications during the 2nd trimester of pregnancy: 1 patient was diagnosed with tocolytic-associated pulmonary edema, and the other had septicemia-related ARDS. Both of them had received prolonged tocolytic treatment presenting with dyspnea, fever, and hemodynamic instability, and required invasive ventilation; they both received fluid and vasopressor management guided by a pulmonary artery catheter and the best supportive care. The 2 patients survived and were weaned from the mechanical ventilator successfully during their stay at the intensive care unit (ICU). Their babies survived, although 1 was delivered in the ICU on the 4(superscript th) day due to precipitated labor. In this case, the mother and her baby required long-term rehabilitation after discharge.

並列關鍵字

tocolytic treatment ； acute respiratory failure ； pulmonary edema ； acute respiratory distress syndrome