Ridgway L E, Martin R W, Hess L W, Buchanan J, Whitworth N S, Martin J N
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson.
Am J Perinatol. 1991 May;8(3):222-6. doi: 10.1055/s-2007-999383.
Acute gestational pyelonephritis infrequently leads to nonhydrostatic permeability pulmonary edema known clinically as acute respiratory distress syndrome (ARDS). In this form of ARDS, sepsis is considered the primary cause of pulmonary dysfunction. Decreases in colloid osmotic pressure, plasma fibronectin, and arterial oxygen saturation are associated with a worsening prognosis in septic conditions. We sought to investigate the changes in these parameters with acute gestational pyelonephritis to gain insight into the factors that may place the patient at risk for sepsis-related morbidity. Colloid osmotic pressure, plasma fibronectin, and arterial oxygen saturation via pulse oximetry were prospectively measured during the inpatient treatment of 17 pregnant patients with acute gestational pyelonephritis. All three parameters achieved their nadir within 24 hours of hospitalization and the initiation of therapy. Although no patient developed significant pulmonary dysfunction, we believe that patient susceptibility for pulmonary edema and general morbidity could be maximal in the first 24 hours after therapy. Future studies using a larger number of patients may identify one or more of these laboratory parameters as helpful in identifying gravid patients who are at risk of developing gestational ARDS.
急性妊娠期肾盂肾炎很少导致临床上称为急性呼吸窘迫综合征（ARDS）的非静水压性通透性肺水肿。在这种形式的ARDS中，脓毒症被认为是肺功能障碍的主要原因。胶体渗透压、血浆纤维连接蛋白和动脉血氧饱和度的降低与脓毒症状态下预后恶化相关。我们试图研究急性妊娠期肾盂肾炎时这些参数的变化，以深入了解可能使患者有发生脓毒症相关发病风险的因素。在17例急性妊娠期肾盂肾炎孕妇住院治疗期间，前瞻性地测量了胶体渗透压、血浆纤维连接蛋白以及通过脉搏血氧饱和度测定的动脉血氧饱和度。所有这三个参数在住院和开始治疗后的24小时内降至最低点。虽然没有患者出现明显的肺功能障碍，但我们认为，治疗后的头24小时内患者发生肺水肿和全身发病的易感性可能最高。未来使用更多患者的研究可能会确定这些实验室参数中的一个或多个有助于识别有发生妊娠期ARDS风险的孕妇。
