Miyoshi Toru, Kawakami Hideo, Hori Reiko, Nakanishi Kazuo, Kusumoto Takehisa, Kono Yusuke, Kido Shinsuke, Oshita Akira, Matsuoka Hiroshi
Department of Cardiology, Ehime Prefectural Imabari Hospital, Imabari, Ehime, Japan.
Department of Gynecology, Ehime Prefectural Imabari Hospital, Imabari, Ehime, Japan.
J Cardiol Cases. 2019 Feb 26;19(6):186-189. doi: 10.1016/j.jccase.2019.01.004. eCollection 2019 Jun.
A 39-year-old woman developed a pulmonary embolism at 28 weeks of gestation, after a 4-week period of bedrest, and required emergencycesarean section due to a decrease in fetal heart rate. Pulseless electrical activity (PEA) developed after intravenous anesthesia. The fetus was delivered 5 min after PEA onset, during cardiopulmonary resuscitation of the mother. Intravenous recombinant tissue-plasminogen activator injection, percutaneous cardiopulmonary support, and 24-h hypothermia therapy were administered to the mother, followed by inferior vena cava filter insertion, combined with catheter thrombus fragmentation and percutaneous thrombectomy. Both the patient and her baby survived. Massive pulmonary embolism with pregnancy may result in death of both mother and child. In this case, after maternal cardiac arrest due to massive pulmonary embolism, the fetus was delivered by cesarean section, followed by thrombolysis treatment using recombinant tissue-plasminogen activator and percutaneous cardiac pulmonary support, pulmonary thrombectomy which was performed on day 3 was effective. Both the patient and her baby survived.>.
一名39岁女性在妊娠28周时,经过4周的卧床休息后发生了肺栓塞,并因胎儿心率下降而需要紧急剖宫产。静脉麻醉后出现了无脉电活动(PEA)。在母亲进行心肺复苏期间,PEA发作5分钟后胎儿娩出。对母亲给予静脉注射重组组织型纤溶酶原激活剂、经皮心肺支持和24小时低温治疗,随后插入下腔静脉滤器,并结合导管血栓碎裂和经皮血栓切除术。患者和她的宝宝均存活。妊娠合并大面积肺栓塞可能导致母婴死亡。在本病例中,由于大面积肺栓塞导致母亲心脏骤停后,通过剖宫产娩出胎儿,随后使用重组组织型纤溶酶原激活剂进行溶栓治疗并给予经皮心肺支持,第3天进行的肺血栓切除术有效。患者和她的宝宝均存活。