剖宫产术后呼吸窘迫综合征19例临床分析

目的:分析剖宫产术后发生呼吸窘迫综合征(ARDS)的发病原因及临床特点。方法:回顾性分析2005年1月至2015年12月第三军医大学附属西南医院收治的剖宫产后诊断为ARDS的产妇19例的临床资料。结果:只有6例(31.6%)被诊断为上呼吸道感染或肺炎,其中剖宫产术前有上呼吸道感染或肺炎临床表现的仅3例。剖宫产手术指征为:重度子痫前期10例(合并部分性前置胎盘1例、中央性前置胎盘1例),轻度子痫前期1例,绒毛膜羊膜炎2例,瘢痕子宫合并边缘性前置胎盘1例,羊水过少1例,相对头盆不称2例,妊娠期急性脂肪肝1例,血小板减少合并重度贫血1例。剖宫产后发生ARDS的时间24~56小时2例,术后24小时内发生8例,术中及术后即刻发生9例。需要呼吸机治疗9例(47.4%),所有患者均好转出院。结论:应警惕妊娠期特有加重肺水肿及肺部感染的疾病,严格控制剖宫产手术指征并加强围手术期管理。

Clinical Analysis of 19 Cases of Acute Respiratory Distress Syndrom e after Caesarean Section

Objective:To analyze the causes and the clinical features of acute respiratory distress syndrome(ARDS) after the caesarean section(CS).Methods:Retrospective analysis was conducted on the 19 cases with ARDS after CS that were treated in Southwest Hospital of Third Military Medical University between January 2005 and December 2015.Results:Only 6 cases(31. 6%) were diagnosed with upper respiratory infection or pneumonia,3 of them with clinical symptoms.The indications for CS included 10 severe pre-eclampsia( with 1 partial placenta previa,1 central placenta previa),1 mild pre-eclampsia,2 chorioamnionitis,1 scar uterus with marginal placenta previa,1 oligohydramnios,2 relative cephalopelvic disproportion,1 acute fatty liver of pregnancy and 1 thrombocytopenia with severe anmia.The ARDS onset time of 2 cases occurred after 24 ~ 56 h of the CS.8 cases within 24 h and 9 cases during CS.9 cases( 47. 4%) were treated with ventilator. All of them recovered and discharged.Conclusions:We should be alert for the diseases that can aggravate the pulmonary edema and infections during pregnancy,and the CS indications should be strictly controled