DiFederico E M, Burlingame J M, Kilpatrick S J, Harrison M, Matthay M A
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco 94143-0624, USA.
Am J Obstet Gynecol. 1998 Oct;179(4):925-33. doi: 10.1016/s0002-9378(98)70190-5.
This study was designed to determine the etiology, course, and severity of pulmonary edema in obstetric patients in a tertiary care center.
A retrospective study was carried out on 16,810 deliveries from University of California, San Francisco, 1985-1995. Diagnosis and severity of lung injury were defined by a 4-point system that was based on the chest radiograph, oxygenation, positive end-expiratory pressure, and lung compliance. Resolution of pulmonary edema was defined by improvement in the chest radiograph and hypoxemia (ratio of arterial oxygen tension to inspired oxygen concentration) scores or by extubation.
Pulmonary edema developed in 86 patients, or 0.5% of all obstetric cases. It usually showed extensive air space consolidation on the chest radiograph and arterial hypoxemia. Although 43% of the patients had severe pulmonary dysfunction, the average time to resolution of pulmonary edema was 2.4 days. Only 45% of patients required admission to the intensive care unit and only 15% required intubation and positive-pressure ventilation. Patients with infection (mean of 7.2 days) or fetal surgery (mean of 3.8 days) had the most severe, protracted course.
Although obstetric pulmonary edema is associated with extensive radiographic infiltrates and severe hypoxemia, resolution occurs rapidly in most patients, limiting the need for intensive care support.
本研究旨在确定三级医疗中心产科患者肺水肿的病因、病程及严重程度。
对1985年至1995年加利福尼亚大学旧金山分校的16810例分娩进行回顾性研究。肺损伤的诊断和严重程度通过基于胸部X光片、氧合、呼气末正压和肺顺应性的4分制来定义。肺水肿的消退通过胸部X光片和低氧血症（动脉血氧分压与吸入氧浓度之比）评分的改善或拔管来定义。
86例患者发生肺水肿，占所有产科病例的0.5%。胸部X光片通常显示广泛的肺泡实变和动脉低氧血症。虽然43%的患者有严重的肺功能障碍，但肺水肿消退的平均时间为2.4天。只有45%的患者需要入住重症监护病房，只有15%的患者需要插管和正压通气。感染患者（平均7.2天）或接受胎儿手术的患者（平均3.8天）病程最严重且迁延。
虽然产科肺水肿与广泛的影像学浸润和严重低氧血症有关，但大多数患者肺水肿消退迅速，减少了对重症监护支持的需求。
