重度子痫前期/子痫合并急性呼吸窘迫综合征的诊断与处理

The diagnosis and management of preeclampsia/eclampsia complicated by acute respiratory distress syndrom(ARDS)—5 cases report

目的探讨重度子痫前期/子痫合并急性呼吸窘迫综合征(acute resp iratory d istress syndrom e,ARDS)原因、早期诊断与处理。方法回顾性分析2003年1月至2005年1月治疗的5例重度子痫前期/子痫合并ARDS临床资料。结果本院同期重度子痫前期/子痫患者60例,合并ARDS者5例,发生率8.3%,5例中4例有严重的合并症。ARDS均表现为急性起病,呼吸频数,氧合指数PaO2/F iO2≤200mmHg,胸片示双肺浸润影。ARDS均在控制重度子痫前期/子痫的同时,使用以无创呼吸机呼气末正压(PEEP)通气吸氧为主的综合治疗,获得治愈。结论重度子痫前期/子痫患者较易并发ARDS,一旦病人呼吸改变或血气异常,应警惕ARDS,治疗关键在于及早应用机械辅助呼气末正压通气(PEEP)吸氧为主的综合治疗。

Objective To study the causes, early diagnoses and treatment of patients with preeclampsia/eclampsia complicated acute respiratory distress syndrome（ARDS）. Mothods from Jan 2003 to Jan 2005, a total of 5 patients with preeclampsia/eclampsia complicated ARDS were reviewed retrospectively. Results 4 in 5 patients have severe complications, they all showed acute onset, tachypnea, bilateral infiltrates on chest x-ray and the index of oxygenation PaO2/FiO2 less than 200mmHg. ARDS was treated with comprehensive management leading by inspiring oxygen with pressure support ventilation by non invasive ventilator with a positive-end expiratory pressure（ PEEP）, At the same time, preeclampsia/eclampsia was treated, all patients have good outcome. Conclusions ARDS occurs more frequently in patients with preeclampsia/eclampsia, once patients show tachypnea and abnormal arterial blood gas , ARDS should be attentioned, the key treatment is comprehensive management leading by inspiring oxygen with pressure support ventilation by non invasive ventilator with a positive-end expiratory pressure（PEEP） should be used earlier.