对哮喘持续状态的孕妇使用救命的体外膜肺氧合（ECMO）
2016/08/22
摘要
哮喘持续状态可以发展成为一种危及生命的疾病，需要机械通气。妊娠期间严重的呼吸衰竭会导致孕妇和胎儿严重的后果。以前的案例研究表明体外膜肺氧合(ECMO)对急性呼吸窘迫综合征（ARDS）的孕妇以及与哮喘持续状态的非妊娠患者可作为一个救命的措施。案例研究一个25岁的女性，怀孕五周，入院时为哮喘持续状态和严重高碳酸血症性呼吸衰竭。尽管救援治疗如用高吸气压力来进行的压力控制通气，吸入β2受体激动剂和抗胆碱药物，静脉注射沙丁胺醇，甲基强的松龙和硫酸镁，她的病情仍然逐渐恶化。启动静脉-静脉体外膜肺氧合（ECMO）用于呼吸支持后，患者的临床状况以及气体交换在接下来的几天里都有所改善。ECMO移除之后两天给患者拔管。然而超声显示逆绒毛血肿；患者诊断为前驱期流产，用镁替代和卧床休息治疗成功了。最后，她在怀孕38周时生下一个健康的男孩。
结论：这是由于哮喘持续状态导致严重呼吸功能不全、对有创机械通气和最大的药物治疗无效的孕妇中使用ECMO成功的第一例。尽管是威胁生命的情况，但对我们的患者使用ECMO大大改善母亲和出生无任何并发症的婴儿的生存机会。
结论：这是由于哮喘持续状态导致严重呼吸功能不全、对有创机械通气和最大的药物治疗无效的孕妇中使用ECMO成功的第一例。尽管是威胁生命的情况，但对我们的患者使用ECMO大大改善母亲和出生无任何并发症的婴儿的生存机会。
（苏欣 审校）
J Asthma. 2016 Jun 24:0. [Epub ahead of print]
The use of life-saving extracorporeal membrane oxygenation (ECMO) for pregnant woman with status asthmaticus.
Steinack C1, Lenherr R2, Hendra H3, Franzen D1.
Author information
Abstract
Introduction Status asthmaticus can develop into a life-threatening disorder that requires mechanical ventilation. Severe respiratory failure during pregnancy can worsen maternal and fetal outcomes. Previous case studies have demonstrated ECMO as a live-saving measure for pregnant women with ARDS as well as non-pregnant patients with status asthmaticus. Case study A 25-year old woman, who was five weeks pregnant, was admitted with status asthmaticus and severe hypercapnic respiratory failure. Despite rescue therapies such as pressure control ventilation with high inspiratory pressures, inhaled beta two agonists and antimuscarinic drugs, intravenous salbutamol, methylprednisolone and magnesium sulfate, her condition gradually deteriorated. Veno-venous extracorporeal membrane oxygenation (ECMO) was initiated for respiratory support and the patient's clinical condition as well as the gas exchange improved within the next few days. ECMO was removed and the patient was extubated after two days. Sonography however revealed a retrochorial hematoma; the patient was diagnosed with abortus imminens and successfully treated with magnesium substitution and bed rest. Finally, she gave birth to a healthy boy at 38 weeks of gestation. Conclusions This is the first case report on the successful use of ECMO in a pregnant woman with severe respiratory insufficiency due to status asthmaticus, who failed to respond to invasive mechanical ventilation and maximum pharmacological treatment. Despite this life-threatening condition, the use of ECMO in our patient has greatly improved the chance of survival for the mother and the baby who was born without any complications.
KEYWORDS:Status asthmaticus; extracorporeal membrane oxygenation (ECMO); mechanical ventilation; pregnancy; respiratory failure
J Asthma. 2016 Jun 24:0. [Epub ahead of print]
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大剂量舌下变应原免疫治疗的不良反应和耐受性
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维生素D3治疗未控制的儿童哮喘初步研究
