Gonçalves Laura, Luís Mariana
Department of Anaesthesiology, Centro Hospitalar Universitário do Porto, Porto, PRT.
Department of Anaesthesiology, Hospital Central do Funchal, Funchal, PRT.
Cureus. 2022 Dec 23;14(12):e32876. doi: 10.7759/cureus.32876. eCollection 2022 Dec.
Acute pulmonary edema (APEd) is rare in pregnancy and in the postpartum period. An intermediate type of APEd characterized as a transudate with a protein concentration between that of cardiogenic and noncardiogenic APEd has been described in the literature. This transudate might actually be the result of capillary pressure having increased to a point of high-permeability edema and/or alveolar hemorrhage. Clinically, the presentation would be a dramatic form of APEd - flash pulmonary edema - characterized by a rapid accumulation of fluid within the lung's interstitial and alveolar spaces as a result of suddenly elevated cardiac filling pressures. Here, we present a case of a healthy pregnant woman who underwent cesarean delivery and developed a constellation of signs and symptoms, suggestive of an APEd, after a supratherapeutic bolus of phenylephrine. During the diagnostic excursion, bilateral parenchymal infiltrations suggestive of hemorrhage were observed on a computed tomography scan. This case highlights the high morbidity associated with adverse drug events and the imperative to prevent them. It also underscores the critical need for careful management of volume shifts and hemodynamics in full-term pregnancies.
急性肺水肿（APEd）在孕期和产后较为罕见。文献中描述了一种中间型APEd，其特征为渗出液，蛋白浓度介于心源性和非心源性APEd之间。这种渗出液实际上可能是毛细血管压力升高至高通透性水肿和/或肺泡出血程度的结果。临床上，其表现为APEd的一种严重形式——急性肺水肿，其特征是由于心脏充盈压突然升高，液体在肺间质和肺泡间隙迅速积聚。在此，我们报告一例健康孕妇，她接受了剖宫产，在静脉注射超治疗剂量的去氧肾上腺素后，出现了一系列提示APEd的体征和症状。在诊断过程中，计算机断层扫描显示双侧实质浸润，提示出血。该病例突出了药物不良事件相关的高发病率以及预防这些事件的必要性。它还强调了在足月妊娠中仔细管理容量变化和血流动力学的迫切需求。
