Bhandari H M, Gorecha M, Woodman J
University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK.
BMJ Case Rep. 2014 Mar 19;2014:bcr2014203676. doi: 10.1136/bcr-2014-203676.
A 35-year-old woman, a non-smoker with a normal body mass index, 'felt wheezy' and developed profound hypoxia 30 min after preterm vaginal delivery at 24+ weeks of gestation. She denied other symptoms, had no fever but was tachycardic and tachypnoeic with normal blood pressure. Pulmonary embolism, amniotic fluid embolism, cardiomyopathy, arrhythmias, sepsis and non-cardiogenic pulmonary oedema were considered as differential diagnoses. Chest X-ray showed an increased pulmonary vasculature, but the blood tests, ECG, echocardiogram and CT pulmonary angiogram were essentially normal. She was managed on a high dependency area with high-flow oxygen and intravenous antibiotics. She improved dramatically and the oxygen requirements dropped to 2 L over the next 4 h. It is plausible that this woman had acute non-cardiogenic pulmonary oedema secondary to a combination of risk factors. This case highlights the importance of a methodical and multidisciplinary approach for a prompt diagnosis and successful treatment of an acutely ill parturient.
一名35岁女性，不吸烟，体重指数正常，在妊娠24 +周时早产经阴道分娩后30分钟出现“喘息感”并发展为严重缺氧。她否认有其他症状，无发热，但心动过速、呼吸急促，血压正常。鉴别诊断考虑了肺栓塞、羊水栓塞、心肌病、心律失常、败血症和非心源性肺水肿。胸部X线显示肺血管纹理增多，但血液检查、心电图、超声心动图和CT肺动脉造影基本正常。她在高依赖病房接受了高流量氧气和静脉抗生素治疗。她病情显著改善，在接下来的4小时内氧气需求量降至2升。这名女性很可能因多种危险因素合并导致急性非心源性肺水肿。该病例凸显了采用系统的多学科方法对急性发病产妇进行快速诊断和成功治疗的重要性。
