Jacobs R, Honore P M, Hosseinpour N, Nieboer K, Spapen H D
ICU dept, Universitair Ziekenhuis Brussel, Belgium.
Acta Clin Belg. 2012 May-Jun;67(3):198-200. doi: 10.2143/ACB.67.3.2062655.
Acute cardiac arrest during pregnancy is a rare but devastating event. Major causes are haemorrhagic, septic or anaphylactic shock, trauma, pulmonary or amniotic fluid embolism, and congenital or acquired cardiac disease. We present a case of massive intrathoracic migration of viscera through a left diaphragmatic hernia in a pregnant multipara, causing acute obstructive shock and cardiac arrest. Complications of intrathoracic herniation occur when the intruding viscera cause left lung and cardiac compression or mediastinal "tamponade" with decreased venous return. Intrathoracic strangulation of viscera is also common and may cause ischaemia, gangrene and eventual perforation. Sudden cardiac arrest as first sign of left diaphragmatic rupture during pregnancy, however, has rarely been described. In contrast with our patient, this catastrophic event is mostly seen in nulli- and primipara with a known congenital left diaphragmatic defect. Management of a diaphragmatic hernia depends on the clinical presentation and the period of gestation during which it is detected. Despite prolonged resuscitation with more than 1 hour of chest compressions, our patient recovered completely.
妊娠期急性心脏骤停是一种罕见但极具破坏性的事件。主要病因包括出血性、感染性或过敏性休克、创伤、肺或羊水栓塞以及先天性或后天性心脏病。我们报告一例经产妇妊娠期间因左侧膈疝导致大量内脏胸腔内移位，引起急性梗阻性休克和心脏骤停的病例。当疝入的内脏导致左肺和心脏受压或纵隔“填塞”伴静脉回流减少时，就会发生胸腔内疝的并发症。胸腔内内脏绞窄也很常见，可能导致缺血、坏疽并最终穿孔。然而，妊娠期左侧膈肌破裂以突发心脏骤停为首发症状的情况鲜有报道。与我们的患者不同，这种灾难性事件多见于有已知先天性左侧膈肌缺损的未产妇和初产妇。膈疝的治疗取决于临床表现和发现时的孕周。尽管进行了超过1小时胸外按压的长时间复苏，我们的患者仍完全康复。
