Steinack Carolin, Lenherr Renato, Hendra Heidy, Franzen Daniel
a Division of Pulmonology , University Hospital Zurich , Zurich , Switzerland.
b Surgical Intensive Care Unit , University Hospital Zurich , Zurich , Switzerland.
J Asthma. 2017 Jan 2;54(1):84-88. doi: 10.1080/02770903.2016.1193871. Epub 2016 Jun 24.
Status asthmaticus can develop into a life-threatening disorder that requires mechanical ventilation. Severe respiratory failure during pregnancy can worsen maternal and fetal outcomes. Previous case studies have demonstrated extracorporeal membrane oxygenation (ECMO) as a life-saving measure for pregnant women with acute respiratory distress syndrome (ARDS) as well as non-pregnant patients with status asthmaticus.
A 25-year-old woman, who was 5 weeks pregnant, was admitted with status asthmaticus and severe hypercapnic respiratory failure. Despite rescue therapies such as pressure control ventilation with high inspiratory pressures, inhaled beta2 agonists and antimuscarinic drugs, intravenous salbutamol, methylprednisolone and magnesium sulfate, her condition gradually deteriorated. Veno-venous ECMO was initiated for respiratory support and the patient's clinical condition as well as the gas exchange improved within the next few days. ECMO was removed and the patient was extubated after 2 days. Sonography, however, revealed a retrochorial hematoma; the patient was diagnosed with abortus imminens and successfully treated with magnesium substitution and bed rest. Finally, she gave birth to a healthy boy at 38 weeks of gestation.
This is the first case report on the successful use of ECMO in a pregnant woman with severe respiratory insufficiency due to status asthmaticus, who failed to respond to invasive mechanical ventilation and maximum pharmacological treatment. Despite this life-threatening condition, the use of ECMO in our patient has greatly improved the chance of survival for the mother and the baby, who was born without any complications.
哮喘持续状态可发展为危及生命的疾病，需要机械通气。妊娠期严重呼吸衰竭会使母婴结局恶化。既往病例研究表明，体外膜肺氧合（ECMO）是治疗患有急性呼吸窘迫综合征（ARDS）的孕妇以及患有哮喘持续状态的非孕妇的一种挽救生命的措施。
一名25岁、孕5周的女性因哮喘持续状态和严重高碳酸血症性呼吸衰竭入院。尽管采取了诸如高吸气压力的压力控制通气、吸入β2激动剂和抗毒蕈碱药物、静脉注射沙丁胺醇、甲泼尼龙和硫酸镁等抢救治疗措施，但其病情仍逐渐恶化。启动静脉 - 静脉ECMO进行呼吸支持，患者的临床状况以及气体交换在接下来的几天内得到改善。2天后移除ECMO并拔除气管插管。然而，超声检查发现了绒毛膜后血肿；该患者被诊断为难免流产，并通过补充镁剂和卧床休息成功治疗。最后，她在妊娠38周时生下了一个健康的男婴。
这是首例关于成功应用ECMO治疗因哮喘持续状态导致严重呼吸功能不全的孕妇的病例报告，该患者对有创机械通气和最大程度的药物治疗均无反应。尽管病情危及生命，但在我们的患者中使用ECMO极大地提高了母亲和婴儿的生存机会，婴儿出生时没有任何并发症。
