Liu Chiwen, Jiang Li, Yuan Donglan, Xu Xinlan, Wei Jing
Department of Obstetrics and Gynecology, The Affiliated Taizhou People's Hospital of Nanjing Medical University (Taizhou People's Hospital), Taizhou, China.
Front Med (Lausanne). 2025 Mar 17;12:1526880. doi: 10.3389/fmed.2025.1526880. eCollection 2025.
Severe respiratory dysfunction during pregnancy, though rare, represents a life-threatening condition, often presenting as dyspnea and respiratory distress. Pregnant patients with pulmonary vascular disease are particularly vulnerable, facing a poor prognosis and a heightened risk of mortality. This report aimed to highlight strategies for mitigating severe complications in high-risk pregnant women and to provide valuable insights into effective clinical management approaches.
We presented the case of a 40-year-old pregnant woman who required hospitalization for intensive monitoring of vital signs. On admission, her temperature was 36.2°C, respiratory rate 25 breaths per minute, blood pressure 108/84 mmHg, and heart rate 87 beats per minute. Notably, her resting blood oxygen saturation was critically low at 80%. A bedside chest X-ray revealed right lung atelectasis with increased interstitial markings and thickening in the left lung. Computed tomographic angiography (CTA) of the thoracic aorta demonstrated a mildly dilated and tortuous bronchial artery supplying the right lung. The patient subsequently developed pulmonary hemorrhage, atelectasis, and pulmonary infection, ultimately progressing to respiratory failure due to congenital bronchial artery malformation. A multidisciplinary intervention strategy was implemented, incorporating extracorporeal membrane oxygenation (ECMO), bronchial artery embolization, fiberoptic bronchoscopic suctioning, alveolar lavage, and comprehensive life support measures. ECMO combined with fiberoptic bronchoscope thrombectomy proved to be instrumental in stabilizing her condition, leading to significant clinical improvement and a successful discharge.
Pulmonary vascular disease-induced hemodynamic instability imposed a substantial risk of circulatory shock in pregnancy. This case underscored the efficacy of ECMO and fiberoptic bronchoscope thrombectomy in the management of severe respiratory dysfunction during pregnancy, advocating for their integration into clinical practice for similar high-risk cases.
孕期严重呼吸功能障碍虽罕见，但却是危及生命的状况，常表现为呼吸困难和呼吸窘迫。患有肺血管疾病的孕妇尤其脆弱，预后不良且死亡风险增加。本报告旨在强调减轻高危孕妇严重并发症的策略，并提供有效临床管理方法的宝贵见解。
我们介绍了一名40岁孕妇的病例，她因生命体征的密切监测而需要住院治疗。入院时，她的体温为36.2°C，呼吸频率为每分钟25次，血压为108/84 mmHg，心率为每分钟87次。值得注意的是，她静息时的血氧饱和度极低，仅为80%。床边胸部X光显示右肺肺不张，间质纹理增多，左肺增厚。胸主动脉计算机断层血管造影（CTA）显示供应右肺的支气管动脉轻度扩张和迂曲。患者随后出现肺出血、肺不张和肺部感染，最终因先天性支气管动脉畸形进展为呼吸衰竭。实施了多学科干预策略，包括体外膜肺氧合（ECMO）、支气管动脉栓塞、纤维支气管镜吸痰、肺泡灌洗和全面的生命支持措施。ECMO联合纤维支气管镜血栓切除术被证明有助于稳定她的病情，导致临床显著改善并成功出院。
肺血管疾病引起的血流动力学不稳定在孕期带来了循环休克的重大风险。该病例强调了ECMO和纤维支气管镜血栓切除术在孕期严重呼吸功能障碍管理中的有效性，主张将其纳入类似高危病例的临床实践。
