妊娠合并急性呼吸窘迫综合征并以血行播散型肺结核为首发表现患者的早期血液净化治疗：1 例报告。
The role of early blood purification for miliary tuberculosis presenting as acute respiratory distress syndrome in pregnancy: A case report.
机构信息
Department of Internal Medicine, Fatmawati Central General Hospital South Jakarta, DKI Jakarta, Indonesia.
Intensivist, Anesthesiology Department, Fatmawati Central General Hospital South Jakarta, DKI Jakarta, Indonesia.
出版信息
Medicine (Baltimore). 2023 Apr 21;102(16):e33523. doi: 10.1097/MD.0000000000033523.
RATIONALE
Acute respiratory distress syndrome (ARDS) in miliary tuberculosis (TB) remains rare, especially in pregnant women. The role of blood purification is potential in managing ARDS due to miliary TB.
PATIENT CONCERNS
A 36-year-old woman presenting with difficulty breathing 6 hours before admission. She never had any constitutional symptoms due to TB.
DIAGNOSES
ARDS in TB was diagnosed based on the deterioration of PaO2/FiO2, increased acute phase reactants, positive gene-Xpert, and typical chest x-ray of miliary TB.
INTERVENTIONS
A C-section was performed and followed by continuous venovenous hemofiltration to tackle her inflammatory condition. antituberculosis drugs were given after the transaminases showed declining trends.
OUTCOMES
No major complications associated with continuous venovenous hemofiltration occurred. After 14 days of hospitalization, the patient's clinical condition improved and was finally discharged.
LESSONS
This case underscores the potential role of blood purification in ARDS due to miliary TB in pregnancy.
背景
粟粒性肺结核（TB）导致的急性呼吸窘迫综合征（ARDS）仍较为罕见，尤其是在孕妇中。由于粟粒性 TB 引起的 ARDS，血液净化可能具有一定的作用。
病例介绍
一名 36 岁女性，入院前 6 小时出现呼吸困难。她从未有过任何因 TB 引起的全身症状。
诊断
根据 PaO2/FiO2 的恶化、急性时相反应物的增加、Gene-Xpert 阳性和典型的粟粒性 TB 胸部 X 线片，诊断为 TB 所致 ARDS。
干预措施
进行了剖宫产，随后进行连续静脉-静脉血液滤过以解决其炎症情况。在转氨酶呈下降趋势后，给予抗结核药物。
结果
未发生与连续静脉-静脉血液滤过相关的重大并发症。住院 14 天后，患者的临床状况改善，最终出院。
结论
该病例强调了血液净化在妊娠合并粟粒性 TB 所致 ARDS 中的潜在作用。
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