Grimme Ina, Winter Ralf, Kluge Stefan, Petzoldt Martin
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
BMJ Case Rep. 2012 Aug 24;2012:bcr2012006741. doi: 10.1136/bcr-2012-006741.
A 23-year-old woman developed massive pulmonary haemorrhage in the 19th week of pregnancy. Essential invasive ventilation was seriously impaired by the mechanical properties of the blood-filled lungs. Consecutive severe respiratory failure (pO(2) 10 mm Hg, pCO(2) 320 mm Hg, pH 6.73) induced a cardiac arrest. Bronchoscopy could not identify the source of bleeding. During 45 min of cardiopulmonary resuscitation, veno-venous extracorporeal membrane oxygenation (ECMO) was installed. Subsequently, neither a high-resolution CT (HRCT) scan nor pulmonary angiography could identify the origin of the haemorrhage. Finally, the excessive pulmonary bleeding was controlled by placing an endobronchial blocker in the middle lobe bronchus. However, pulmonary haemorrhage reoccurred and this time HRCT revealed an isolated bronchiectasis in the middle lobe. Based on this finding, surgical lobectomy was performed. The patient recovered fully without any neurological sequelae. A solitary bronchiectasis has not previously been described as a cause of massive pulmonary haemorrhage in pregnancy.
一名23岁女性在妊娠第19周时发生大量肺出血。充满血液的肺的机械特性严重妨碍了必要的有创通气。连续的严重呼吸衰竭（动脉血氧分压10 mmHg，动脉血二氧化碳分压320 mmHg，pH值6.73）导致心脏骤停。支气管镜检查未能确定出血来源。在45分钟的心肺复苏过程中，安装了静脉-静脉体外膜肺氧合（ECMO）。随后，高分辨率CT（HRCT）扫描和肺血管造影均未能确定出血起源。最后，通过在中叶支气管放置支气管内封堵器控制了严重的肺出血。然而，肺出血再次发生，此次HRCT显示中叶有孤立性支气管扩张。基于这一发现，实施了手术肺叶切除术。患者完全康复，无任何神经后遗症。此前尚未将孤立性支气管扩张描述为妊娠期间大量肺出血的原因。
