Doménech Asensi P, Hernández-Palazón J, Tortosa Serrano J A, Burguillos López S, Alonso Miranda B
Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de la Arrixaca, Murcia.
Rev Esp Anestesiol Reanim. 2002 Mar;49(3):156-9.
A 26-year-old woman in the thirty-second week of her fifth pregnancy was admitted with diffuse sudden-onset abdominal pain. Examination revealed cervical dilation to 8 cm, a ruptured uterine cerclage and transverse presentation of the fetus, indicating a need for emergency cesarean section, which was performed under uneventful spinal anesthesia. Three days after surgery the patient presented signs consistent with acute pulmonary edema coinciding with blood transfusion. Echocardiography demonstrated left ventricular systolic dysfunction with an ejection fraction of 35%. The diagnosis was peripartum myocardiopathy with acute respiratory insufficiency due to heart failure. Furosemide and captopril were prescribed and the outcome was satisfactory. The discharge echocardiogram showed a left ventricle of normal size and thickness, and the ejection fraction was 55%. Peripartum myocardiopathy is a type of heart failure that develops during the third trimester or during the first six months after delivery, in the absence of signs of ventricular dysfunction or previous heart disease. Based on clinical presentation and echocardiographic findings, we believe that peripartum myocardiopathy was the cause of acute pulmonary edema in this patient.
一名26岁、孕5产的女性，孕32周，因突发弥漫性腹痛入院。检查发现宫颈扩张至8厘米，子宫颈环扎术破裂，胎儿横位，提示需紧急剖宫产，手术在平稳的脊髓麻醉下进行。术后三天，患者出现与输血同时发生的急性肺水肿症状。超声心动图显示左心室收缩功能障碍，射血分数为35%。诊断为围产期心肌病伴因心力衰竭导致的急性呼吸功能不全。给予呋塞米和卡托普利治疗，结果令人满意。出院时的超声心动图显示左心室大小和厚度正常，射血分数为55%。围产期心肌病是一种在妊娠晚期或分娩后前六个月发生的心力衰竭类型，不存在心室功能障碍或既往心脏病的体征。根据临床表现和超声心动图结果，我们认为围产期心肌病是该患者急性肺水肿的病因。
