Bonfante Ramírez E, Ahued Ahued R, García-Benítez C Q, Bolaños Ancona R, Callejos T, Juárez García L
Instituto Nacional de Perinatología SSA, México, D.F.
Ginecol Obstet Mex. 1997 Apr;65:137-40.
Shock is one of the most difficult problems an obstetrician can face. Hemorrhage is the main reason of shock. A descriptive and retrospective research was conducted at Instituto Nacional de Perinatología, from January 1992 to May 1996, including all patients admitted to the intensive care unit with diagnosis of shock. There were found 90 cases with diagnosis of shock, 82 were hipovolemic, and 8 cases had the septic kind of shock. The average of age was 32.2 years, with a gestational age between 6.2 to 41.4 weeks . There were 71 healthy patients, hypertension was associated to pregnancy in 9 cases, infertility in two, myomatosis in 2, and diabetes in 2 more patients. Other 5 cases reported different pathologies. The most frequent cause for hipovolemic shock resulted to be placenta acreta (40 cases), followed by uterine tone alterations in 37 patients, ectopic pregnancy in 7, uterine rupture or perforation in 4, and vaginal or cervical lacerations in 2. The estimated blood loss varied from 2200 cc to 6500 cc, and the minimal arterial pressure registered during shock was between 40/20 mmHg to 90/60 mmHg. Medical initial assistance consisted in volume reposition with crystalloids, globular packages, and plasma expansors in 73 patients (81.1%). The rest of the patients received in addition coloids, platelets and cryoprecipitates. A total of 76 patients required surgical intervention consisting in total abdominal hysterectomy. In 5 cases the previous surgical procedure was done and ligation of hypogastric vessels was needed. Salpingectomy was performed in 5 patients, and rupture or perforation repair in 3. The average surgery time was 2 hours and 33 minutes. The observed complications were 7 cases with abscess of the cupula, consumption coagulopathy in 2, 1 vesical quirurgical injury, 1 intestinal occlusion, and 11 vesico-vaginal fistula. The average days of hospitalization resulted to be 5. The most frequent kind of shock seen by obstetricians is the hipovolemic type, followed by septic shock, Volume reposition and restoration of adequate tissue oxygenation is the main goal in treatment, and so the rapid and opportune decision for surgery shall prevent the patients decriment and maternal mortality.
休克是产科医生可能面临的最棘手问题之一。出血是休克的主要原因。1992年1月至1996年5月在国立围产医学研究所进行了一项描述性回顾性研究，纳入所有入住重症监护病房且诊断为休克的患者。共发现90例休克病例，其中82例为低血容量性休克，8例为感染性休克。平均年龄为32.2岁，孕周在6.2至41.4周之间。有71例健康患者，9例合并妊娠高血压，2例合并不孕症，2例合并子宫肌瘤，另有2例合并糖尿病。其他5例报告有不同病症。低血容量性休克最常见的原因是胎盘植入（40例），其次是37例子宫收缩异常，7例异位妊娠，4例子宫破裂或穿孔，2例阴道或宫颈裂伤。估计失血量在2200毫升至6500毫升之间，休克期间记录的最低动脉压在40/20毫米汞柱至90/60毫米汞柱之间。73例患者（81.1%）的初始医疗救助包括用晶体液、血球制剂和血浆扩容剂进行容量补充。其余患者还接受了胶体液、血小板和冷沉淀。共有76例患者需要手术干预，包括全腹子宫切除术。5例患者之前已进行过手术，需要结扎髂内血管。5例患者进行了输卵管切除术，3例进行了破裂或穿孔修复。平均手术时间为2小时33分钟。观察到的并发症包括7例膈下脓肿，2例消耗性凝血病，1例膀胱手术损伤，1例肠梗阻，以及11例膀胱阴道瘘。平均住院天数为5天。产科医生最常遇到的休克类型是低血容量性休克，其次是感染性休克。容量补充和恢复足够的组织氧合是治疗的主要目标，因此快速且适时的手术决策应可防止患者病情恶化和孕产妇死亡。
