妊娠晚期危重型新型冠状病毒肺炎一例

A critically ill mother with COVID-19 in late pregnancy:a case report

本文报告一例妊娠晚期合并新型冠状病毒肺炎(COVID-19)危重型孕妇。患者32岁,孕35周+2因"咽痛4 d,发热3 h"入院。入院前曾至湖北孝感应城,回家隔离期间发病。入院后病情进展迅速,7 h后出现左侧胸背部疼痛、气促、头晕,迅即出现呼吸衰竭、感染性休克。考虑病情严重,且有2次剖宫产史,行紧急子宫下段剖宫产术。术前血气分析示呼吸衰竭、呼吸性酸中毒合并代谢性酸中毒。术中娩出一男婴,2700 g,1 min Apgar评分1分(心率20次/min),经复苏抢救,5和10 min评分均为1分,家属放弃抢救后死亡。产妇术后气管插管呼吸机维持,同时给予其他支持治疗。入院时的新型冠状病毒核酸检测结果于分娩后报告为阳性,遂转入定点医院治疗。患者术后26 d体外膜肺氧合脱机成功,术后36 d脱离呼吸机,进入康复阶段。

We report a critically ill pregnant woman in the third trimester with severe pneumonia due to COVID-19 who presented to Xiaolan People's Hospital of Zhongshan in February 2020.The 32-year-old patient was admitted at 35+2 gestational weeks with a 4-day history of a sore throat and a fever for three hours.The patient had been to Xiaogan City,Hubei Province,and the symptoms occurred during a period of self-isolation after back home.The condition of the patient deteriorated rapidly,with left-sided chest and back pain,shortness of breath,dizziness,progressing to respiratory failure and septic shock 7 hours after her admission.In view of her critical condition and a history of two previous cesarean sections,an emergency cesarean section was performed.Blood gas analysis of the mother before the operation suggested respiratory failure,respiratory acidosis,and metabolic acidosis.During the operation,a baby boy was born.The Apgar score of the boy,birth weight of 2700 g,was one at 1,5,and 10 minutes despite the resuscitation efforts.The neonate died after withdrawing treatment.The patient was treated with tracheal intubation ventilator and other supportive treatments after the operation.The result of the new coronavirus nucleic acid test,taken on admission,but which was reported after delivery,was positive.The patient was transferred to the designated hospital for further treatment and was recovering with the withdrawal of extracorporeal membrane oxygenation and ventilation at 26 and 36 days after surgery,respectively.