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新型冠状病毒肺炎感染继发孕产妇死亡:一例病例报告及文献综述

Maternal death secondary to COVID-19 infection: A case report and review of the literature.

作者信息

Stout Annabel, Crichton Robert, Tahmasebi Farshad

机构信息

West Midlands School of Obstetrics and Gynaecology, UK.

Birmingham School of Anaesthesia, Birmingham, UK.

出版信息

Obstet Med. 2021 Dec;14(4):248-252. doi: 10.1177/1753495X20970816. Epub 2020 Nov 20.

DOI:10.1177/1753495X20970816
PMID:34880939
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8646207/
Abstract

Maternal death secondary to coronavirus disease 19 (COVID-19) infection in a previously well woman is described. The woman presented with an eight-day history of productive cough and shortness of breath. Rapid deterioration of respiratory function was seen following admission, with associated tachycardia, tachypnoea and hypoxia. Emergency caesarean section was performed followed by transfer to the intensive care unit. COVID-19 PCR throat swab from day 0 was positive. Later, she developed hypoxaemia refractory to mechanical ventilation, proning and paralysis. The woman was transferred for veno-venous Extra Corporeal Membrane Oxygenation therapy but unfortunately died despite rigorous management. We review the conflicting information regarding physiological and immunological changes occurring during pregnancy and how these may affect susceptibility to respiratory viral disease. An overview of the current literature concerning ventilation and intensive care support in pregnant women suffering from COVID-19 is given. Further documentation of such cases is called for to progress understanding and management strategies.

摘要

本文描述了一名既往健康的女性因新型冠状病毒肺炎(COVID-19)感染导致的孕产妇死亡。该女性出现了为期八天的咳痰咳嗽和呼吸急促症状。入院后呼吸功能迅速恶化,伴有心动过速、呼吸急促和低氧血症。随后进行了紧急剖宫产,之后转至重症监护病房。第0天采集的COVID-19 PCR咽拭子检测呈阳性。后来,她出现了对机械通气、俯卧位通气和麻痹治疗均无效的低氧血症。该女性被转至静脉-静脉体外膜肺氧合治疗,但尽管进行了严格管理,仍不幸死亡。我们回顾了关于孕期发生的生理和免疫变化以及这些变化如何影响对呼吸道病毒疾病易感性的相互矛盾的信息。概述了当前关于COVID-19感染孕妇的通气和重症监护支持的文献。需要进一步记录此类病例,以增进对相关情况的了解并改进管理策略。

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本文引用的文献

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Extracorporeal Life Support in Pregnancy: A Systematic Review.体外生命支持在妊娠中的应用:系统评价。
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BMJ. 2020 Jun 8;369:m2107. doi: 10.1136/bmj.m2107.
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Int J Gynaecol Obstet. 2020 Jul;150(1):47-52. doi: 10.1002/ijgo.13182. Epub 2020 May 17.
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COVID-19 pneumonia: different respiratory treatments for different phenotypes?新冠肺炎:针对不同表型采用不同的呼吸治疗方法?
Intensive Care Med. 2020 Jun;46(6):1099-1102. doi: 10.1007/s00134-020-06033-2. Epub 2020 Apr 14.
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Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19).拯救脓毒症运动:2019 冠状病毒病(COVID-19)危重症成人管理指南。
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