Lee W, Clark S L, Cotton D B, Gonik B, Phelan J, Faro S, Giebel R
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030.
Am J Obstet Gynecol. 1988 Aug;159(2):410-6. doi: 10.1016/s0002-9378(88)80096-6.
A multiinstitutional review of 10 pregnancies complicated by septic shock was undertaken to identify the clinical characteristics and hemodynamic alterations associated with this condition. Prolonged rupture of membranes with the subsequent development of chorioamnionitis or postpartum endometritis were risk factors that commonly preceded the diagnosis of septic shock. The majority of septic shock cases occurred during the puerperium. There were two maternal deaths in this selected series. Associated complications included pulmonary edema, adult respiratory distress syndrome, disseminated intravascular coagulation, pulmonary emboli, and cardiac arrest. The primary hemodynamic derangements were reduced systemic vascular resistance with depressed myocardial function. The mean initial systemic vascular resistance index in eight surviving women was 885 +/- 253 dyne.sec/cm5.m2. Despite an overall presenting cardiac index of 4.20 +/- 2.01 L/min/m2, five patients (50%) had evidence of myocardial depression based on analysis of their left ventricular function curves. Mean arterial pressure, systemic vascular resistance, and left ventricular stroke work index all showed significant improvement after therapy. A hemodynamic algorithm based on volume therapy, inotropic agents, and peripheral vasoconstrictors is offered. This therapeutic approach is designed to optimize cardiac performance and maintenance of organ perfusion in the critically ill patient with septic hypotension during pregnancy.
对10例并发感染性休克的妊娠病例进行了多机构回顾性研究，以确定与该病症相关的临床特征和血流动力学改变。胎膜长时间破裂并随后发展为绒毛膜羊膜炎或产后子宫内膜炎是感染性休克诊断之前常见的危险因素。大多数感染性休克病例发生在产褥期。在这个选定的系列病例中有两例孕产妇死亡。相关并发症包括肺水肿、成人呼吸窘迫综合征、弥散性血管内凝血、肺栓塞和心脏骤停。主要的血流动力学紊乱是全身血管阻力降低和心肌功能抑制。8名存活女性的平均初始全身血管阻力指数为885±253达因·秒/厘米⁵·平方米。尽管总体心脏指数为4.20±2.01升/分钟/平方米，但根据左心室功能曲线分析，5例患者（50%）有心肌抑制的证据。治疗后平均动脉压、全身血管阻力和左心室每搏功指数均有显著改善。提出了一种基于容量治疗、正性肌力药物和外周血管收缩剂的血流动力学算法。这种治疗方法旨在优化妊娠合并感染性低血压危重症患者的心脏功能并维持器官灌注。
