HELLP综合征剖宫产术后发生心肺复苏后综合征一例分析——兼论复苏后综合征的临床思维

Diagnosis and Treatment for a Cardio-Pulmonary Resuscitation(PCR) Patient with HELLP Syndrome(PRS) after Cesarean Section——The Discussion on Clinical Thinking of Post-Resuscitation Syndrome

目的探讨复苏后综合征(post-resuscitation syndrome,PRS)的临床特点及诊治要点,以提高患者生存率并改善预后。方法对我院收治的1例PRS的临床资料进行回顾性分析。结果本例因停经30+4周,血压升高6周,上腹痛1 d入院,诊断为宫内妊娠30+4周、重度子痫前期、HELLP综合征。急诊在全麻下行剖宫取胎术,术后患者因无尿、高钾血症等转入重症监护病房(ICU),予持续床旁连续性肾脏替代治疗(CRRT)中2次出现心室颤动(室颤),予心肺复苏(cardiopumonaryresuscitation,CPR)后恢复窦性心律。复苏后患者昏迷,予脑保护、地塞米松、多巴胺及补镁等治疗,3 d后患者恢复意识,四肢肌力0级,予神经营养药物、针灸等治疗。ICU共治疗46 d出院,随访3个月肌力完全恢复正常。结论 PRS治疗过程中重视脑保护并运用综合手段维持血流动力学的稳定,对于切实提高CPR效果及改善患者预后有重要意义。

Objective To discuss the clinical characteristics and the key points of diagnosis and therapy for post-resuscita- tion syndrome （PRS） so as to improve its survival rate and prognosis. Methods A retrospective analysis was performed on clinical data of a patient with PRS in our hospital. Results The patient was admitted for menolipsis for 30 ＋4 weeks, elevated blood pres- sure for 6 weeks and epigastric pain for 1 day, and was diagnosed as having the intrauterine pregnancy （30 ＋4 weeks ）, severe pre- eclampsia and HELLP syndrome. The emergency cesarean section with general anesthesia was performed and the patient was trans- ferred to ICU after operation due to anuria. During the process of continuous renal replacement therapy （CRRT）, the patient suf- fered a sudden onset of ventricular fibrillation for twice and sinus rhythm was recovered after cardiopulmonary resuscitation （CPR）, but the patient was still in a coma. Brain protection combined with treatment of dexamethasone, dopamine and magnesium were per- formed. The patient came to consciousness after 3 days but with extremities muscle strength in grade zero and received the treatment of neurotrophic drugs and acupuncture. After 46 days of the treatment the patient was discharged from hospital, and the patient＇mus- cle strength was fully recovered as shown by a 3-months follow-up. Conclusion Brain protection and maintaining the stability of hcmodynamics with compositive means may play a key role in the treatment of PRS, which is of important significance in prognosis. [