DiFederico E M, Harrison M, Matthay M A
University of California and the Cardiovascular Research Institute, San Francisco, USA.
Chest. 1996 Apr;109(4):1114-7. doi: 10.1378/chest.109.4.1114.
Most cases of acute lung injury in pregnancy are attributed to hydrostatic pulmonary edema. In this report, however, we describe a 20-year-old pregnant woman who developed a unique case of increased permeability pulmonary edema following surgery for the repair of a fetal congenital diaphragmatic hernia. Two days after surgery, the patient developed acute respiratory failure and diffuse alveolar edema, requiring intubation and positive pressure ventilation for 5 days. The diagnosis of increased permeability pulmonary edema was confirmed by the ratio of pulmonary edema fluid to plasma protein (ratio=0.99). The patient received IV nitroglycerine for tocolysis. As a nitric oxide donor, the nitroglycerine may have combined with exogenous oxygen to form peroxynitrite, a known impediment to alveolar epithelial cell function. Many cases of pulmonary edema in pregnancy are diagnosed as hydrostatic based on clinical parameters, such as positive maternal fluid balance. In this case, these parameters would have been misleading. Measurement of the protein concentration in the pulmonary edema fluid allowed us to accurately determine that the patient had increased permeability pulmonary edema as the cause of her acute respiratory failure. Sampling of pulmonary fluid can differentiate the type of edema formation and in some cases help to identify mechanisms of acute lung injury.
妊娠期急性肺损伤的大多数病例归因于静水压性肺水肿。然而，在本报告中，我们描述了一名20岁的孕妇，她在胎儿先天性膈疝修补手术后发生了一例独特的通透性增加性肺水肿。术后两天，患者出现急性呼吸衰竭和弥漫性肺泡水肿，需要插管和正压通气5天。通过肺水肿液与血浆蛋白的比值（比值 = 0.99）证实了通透性增加性肺水肿的诊断。患者接受静脉注射硝酸甘油进行保胎治疗。作为一氧化氮供体，硝酸甘油可能与外源性氧气结合形成过氧亚硝酸根，这是一种已知的肺泡上皮细胞功能障碍因素。许多妊娠期肺水肿病例根据临床参数（如母体液体平衡为正）被诊断为静水压性肺水肿。在本病例中，这些参数会产生误导。测量肺水肿液中的蛋白质浓度使我们能够准确确定患者发生通透性增加性肺水肿是其急性呼吸衰竭的原因。采集肺液样本可以区分水肿形成的类型，在某些情况下有助于识别急性肺损伤的机制。
