妊娠合并重症肺炎5例临床分析

Clinical analysis of 5 pregnant women with severe pneumonia

目的探讨妊娠期重症肺炎的临床特点和治疗方法。方法对郑州大学第一附属医院呼吸ICU科2012年12月至2013年3月期间收治的5例妊娠期重症肺炎患者的临床资料进行回顾性分析。结果①5例重症肺炎发生在妊娠25周～产后1周，4例妊娠期发病，发病后终止妊娠，1例为产后发病。②5例患者均有高热，CT均表现为双肺多发片状高密度影，1例临床诊断肺真菌病，2例拟诊肺真菌病。（耋）4例患者均有I型呼吸衰竭，需呼吸机辅助通气，3例无创机械通气，1例有创机械通气，病程中出现II型呼吸衰竭。④所有患者均有低蛋白血症，病程进展中出现轻度贫血。⑤经抗感染及综合治疗后所有患者均好转或痊愈。结论①妊娠期重症肺炎抗感染治疗时要考虑有无真菌感染，同时注意其他不典型病原体感染，在秋冬季节要注意甲流感染。②早期终止妊娠对肺炎控制及心功能改善均有好处。③改善全身状况，注重心功能、营养治疗对于病情改善有积极意义，经过综合治疗预后较好。

Objective To investigate the clinical features and treatment of severe pneumonia in pregnancy. Methods The clinical data of 5 pregnant patients with severe pneumonia addmitted to the respiratory ICU of the first affiliated hospital of Zhengzhou university from December 2012 to March 2013 were retrospectively analyzed. Results ① 5 cases of severe pneumonia in pregnancy 25 weeks-1 week postpartum. Four pregnant women with the disease and then terminated the pregnancy, 1 case of postpartum. ②All the 5 patients had high fever and CT showed multiple high density in bilateral lung, 1 case of clinical diagnosis of pulmonary fungal disease, 2 cases of suspected pulmonary fungal disease. ③Four patients had type I respiratory failure and need mechanical ventilation, 3 cases of noninvasive mechanical ventilation, 1 case of invasive mechanical ventilation, and type II respiratory failure occured in the progression of the disease. ④All patients had hypoalbuminemia and mild anemia. ⑤Mter the anti-infective and comprehensive treatment, all patients were improved or cured. Conclusions ①Anti-infection treatment of severe pneumonia in pregnancy should consider fungal infection and pay attention to other atypical pathogens in the fall and winter seasons. ②Early termination of pregnancy for pneumonia control and improvement of cardiac function is good. ③Improving the general situation, and focusing on cardiac function, nutritional therapy have a positive significance. The prognosis is good with the comprehensive treatment.