Sereno Colo J A, Pineda Marquez J C
Servicio de Gineco-Obstetricia, Hospital General Dr. Miguel Silva, SSA Morelia, Mich.
Ginecol Obstet Mex. 1990 Dec;58:338-45.
Septic shock in obstetrics is a major cause of mortality. Postpartum endometritis is often the first step of bacterial colonization inside the uterus which becomes the nidus of infection. Rapid spread into general circulation is favoured by hemodynamics patterns of pregnancy. Bacteremia would result in cardiovascular collapse and a myocardial depressant factor has been proposed to explain the fall in cardiac output. Later, endotoxin activates the substances of malignant intravascular inflammation and multiple systems organ failure may be observed in uncontrolled sepsis. Eight cases are reported hospitalized at Morelia's General Hospital, SSA, with septic shock and MSOF. Presumably because of aggressive acute resuscitation nobody succumbed during acute cardiac failure and hypotensive episode but two patients died later with multiple system organ failure. The mortality was 25%. Fluid, resuscitation, and vasoactive drugs are the most effective way to reduce mortality. Antibiotics, specific treatment of MSOF and taking away the nidus of infection are critical components of therapy.
产科感染性休克是主要的死亡原因。产后子宫内膜炎往往是细菌在子宫内定植的第一步，子宫成为感染病灶。妊娠时的血流动力学模式有利于感染迅速扩散至全身循环。菌血症会导致心血管衰竭，有人提出心肌抑制因子来解释心输出量下降。随后，内毒素激活恶性血管内炎症物质，在未控制的脓毒症中可能会出现多系统器官衰竭。本文报告了8例在墨西哥莫雷利亚总医院（SSA）住院的感染性休克和多系统器官衰竭患者。可能由于积极的急性复苏措施，在急性心力衰竭和低血压发作期间无人死亡，但有2名患者后来死于多系统器官衰竭。死亡率为25%。液体复苏和血管活性药物是降低死亡率的最有效方法。抗生素、多系统器官衰竭的特异性治疗以及去除感染病灶是治疗的关键组成部分。
