妊娠合并重症肺炎7例临床分析

Clinical analysis of 7 pregnant women with severe pneumonia

目的了解妊娠期重症肺炎的发病特点、临床经过及治疗和预后。方法对上海交通大学附属第六人民医院2009年8月至12月收治的7例妊娠期重症肺炎患者的临床资料进行回顾性分析。结果 7例重症肺炎发生在妊娠26.6～37周,其中H1N1 3例,肺炎支原体感染1例,病原体不明确3例;1例为医院获得性肺炎;7例患者除有肺炎症状外,均有严重呼吸困难,需呼吸机支持呼吸,血气分析均提示为I型呼吸衰竭;3例患者血压下降,病程2～3周,影像学主要表现为多灶浸润性改变。7例患者中,6例存活,1例死亡。其中4例经积极治疗,妊娠近足月,行剖宫产终止妊娠;1例发病期间早产阴道分娩;1例病情改善继续妊娠;1例来院已多脏器功能衰竭,抢救无效死亡。结论综合治疗是妊娠期重症肺炎患者的主要原则,产科的处理强调个体化,多数患者经综合治疗可取得较好疗效。

Objective To investigate the onset characteristics,clinical course,treatment and prognosis of pregnant patients with severe pneumonia.Methods Clinical data of seven cases of pregnant patients complicated with severe pneumonia who were treated in Shanghai Jiao Tong University Sixth People＇s Hospital from August 2009 to December 2009 were analyzed retrospectively.Results The gestational age were 26.6 weeks to 37 weeks;3 cases were infected with H1N1 virus,1 patient got Mycoplasma pneumonia and the other 3 cases were failed to detect the pathogens,1 case of them was hospital-acquired pneumonia.Unless the symptoms of pneumonia,all patients had severe breathing difficulties and needed ventilator supporting and were diagnosed as I-type respiratory failure.3 of them were with decreased blood pressure.The average duration of the disease was 2～3 weeks.Chest X-ray imaging showed multi-invasive lesions.6 patients survived the disease,1 patient died.4 patients had caesarean section after effective treatment,one patient underwent vaginal delivery prematurely during the incubation period;1 case continued pregnant with improved condition.One case died for severe multi-organ failure.Conclusions Pregnant patients with severe pneumonia need individualized therapy,most patients can achieve better effect after combined treatment.