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一名年轻孕妇致命性围产期心肌病的成功管理:病例报告

Successful management of fatal peripartum cardiomyopathy in a young pregnant woman: A case report.

作者信息

Huang Yaqing, Chen Tianqi, Zhang Meiqi, Yang Xianghong, Ding Guodong, Yang Liwei

机构信息

Department of Obstetrics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College The Second Clinical Medical College, Zhejiang Chinese Medical University Department of Emergency, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College Department of Intensive Care Unit, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College Department of Anesthesia, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.

出版信息

Medicine (Baltimore). 2018 Apr;97(15):e0408. doi: 10.1097/MD.0000000000010408.

DOI:10.1097/MD.0000000000010408
PMID:29642207
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5908600/
Abstract

RATIONALE

Peripartum cardiomyopathy (PPCM) is a rare and life-threatening form of pregnancy associated myocardial disease.

PATIENT CONCERNS

In the present report, we describe a case of a patient with PPCM at 33 weeks of gestation with stillbirth and cardiorespiratory failure.

DIAGNOSES

Peripartum cardiomyopathy.

INTERVENTIONS

The patient underwent emergency cesarean section (CS) and comprehensive medical treatments, including bromocriptine, as well as positive inotropic agents and diuretics after the CS.

OUTCOMES

She had an uneventful recovery period, and was discharged 9 days after surgery. Her heart function was restored within 6 months after CS, and follow-up echocardiographies indicated normal heart function.

LESSONS

This case highlights that early diagnosis and timely termination of pregnancy are crucial in the management of PPCM.

摘要

理论依据

围产期心肌病(PPCM)是一种罕见且危及生命的妊娠相关心肌疾病。

患者情况

在本报告中,我们描述了一例妊娠33周时患有围产期心肌病的患者,出现死产和心肺功能衰竭。

诊断

围产期心肌病。

干预措施

患者接受了急诊剖宫产(CS)及综合药物治疗,包括溴隐亭,剖宫产术后还使用了正性肌力药物和利尿剂。

结果

她恢复过程顺利,术后9天出院。剖宫产术后6个月内心脏功能恢复,后续超声心动图检查显示心脏功能正常。

经验教训

该病例强调早期诊断和及时终止妊娠在围产期心肌病管理中至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e201/5908600/26d548ad6d33/medi-97-e0408-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e201/5908600/26d548ad6d33/medi-97-e0408-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e201/5908600/26d548ad6d33/medi-97-e0408-g001.jpg

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引用本文的文献

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Bromocriptine Use in Peripartum Cardiomyopathy: Review of Cases.溴隐亭在围产期心肌病中的应用:病例回顾
AJP Rep. 2018 Oct;8(4):e335-e342. doi: 10.1055/s-0038-1675832. Epub 2018 Nov 21.

本文引用的文献

1
An update on treatments and outcomes in peripartum cardiomyopathy.围产期心肌病的治疗与预后最新进展
Future Cardiol. 2014 May;10(3):435-47. doi: 10.2217/fca.14.23.
2
Managing cardiovascular disease during pregnancy: best practice to optimize outcomes.孕期心血管疾病的管理:优化结局的最佳实践
Future Cardiol. 2014 May;10(3):421-33. doi: 10.2217/fca.14.21.
3
Outcomes of patients with peripartum cardiomyopathy who received mechanical circulatory support. Data from the Interagency Registry for Mechanically Assisted Circulatory Support.
接受机械循环支持的围产期心肌病患者的结局。来自机械辅助循环支持机构间注册处的数据。
Circ Heart Fail. 2014 Mar 1;7(2):300-9. doi: 10.1161/CIRCHEARTFAILURE.113.000721. Epub 2014 Jan 17.
4
Risk of heart failure relapse in subsequent pregnancy among peripartum cardiomyopathy mothers.围生期心肌病母亲再次妊娠发生心力衰竭的风险。
Int J Gynaecol Obstet. 2010 Apr;109(1):34-6. doi: 10.1016/j.ijgo.2009.10.011. Epub 2009 Nov 30.
5
Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review.围产期心肌病:美国国立心肺血液研究所和罕见病办公室(美国国立卫生研究院)研讨会建议与综述
JAMA. 2000 Mar 1;283(9):1183-8. doi: 10.1001/jama.283.9.1183.
6
A modified definition for peripartum cardiomyopathy and prognosis based on echocardiography.基于超声心动图的围产期心肌病改良定义及预后
Obstet Gynecol. 1999 Aug;94(2):311-6. doi: 10.1016/s0029-7844(99)00293-8.