懷孕中發生反覆性腎盂腎炎併發阻塞性腎水腫及敗血性休克

本文報告一懷孕第34週外籍孕婦因腹痛、寡尿、嘔吐及腰痛就醫。病患有反覆性腎盂腎炎病史，診斷為早產收縮併香腎盂腎炎，除安胎外並投予抗生素。然住院後高燒不退，血壓下降發生敗血性休克，置放尿管亦僅少量尿液流出，超音波發現雙側均有明顯腎及輸尿管水腫，研判為懷孕子宮壓迫造成。放置Double J導管後尿液順利流出，香燒改喜，子宮收縮亦逐漸消失。狀況穩定後出院並持續使用預防抗生素，其後未再發生相同疾症。本案例顯示：組成跨科團隊、及早施行超音波診斷、選用適合抗生素、出院後繼續預防，應對有效治療並防止腎炎反覆發作有較大助益。再者，若加上本案例，我們已發現共五位有類似症狀及診斷病患，全部發生於外籍孕婦，顯示對外籍孕婦衛教及產中追蹤實有再加強必要。

關鍵字

早產收縮；腎水腫；腎盂腎炎；外籍孕婦

並列摘要

We report on a foreign pregnant woman who at 34 weeks gestation visited our hospital because of low abdominal pain, oliguria, vomiting, and flank pain with previous episodes of recurrent pyelonephritis. Preterm contractions complicated with pyelonephritis was our impression, which was treated by tocolytic agents and antibiotics. She suffered from a high fever, however, after admission, which was associated with hypotension, so septic shock was noted. The urine amount was scanty despite an indwelling Foley catheter Ultrasound revealed remarkable bilateral hydronephrosis and hydroureters which might have resulted from compression by the gravid uterus. Urine passed smoothly after inserting bilateral double J catheters. In addition, both the fever and uterine contractions subsided She was discharged after her condition had stabilized Treatment with prophylactic antibiotics was continued, and she was free of disease afterwards Our experience shows that multidisciplinary teamwork, early arrangement of diagnostic ultrasound, the proper selection of antibiotics, and prophylactic antibiotics after discharge may have benefits for the effective treatment and prevention of recurrent pyelonephritis We found a total of 5 cases with similar symptoms and diagnoses in our hospital (including this patient) over the past years. All of them were foreign pregnant women. This reveals that more can be done to empower foreign pregnant women in terms of health education and antepartum follow up.

並列關鍵字

preterm contraction ； hydronephrosis ； pyelonephritis ； foreign pregnant women

國際替代計量

懷孕中發生反覆性腎盂腎炎併發阻塞性腎水腫及敗血性休克

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