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妊娠期和围产期急性呼吸衰竭

Authors
Peter F Clardy, MD
Christine C Reardon, MD
Section Editors
Scott Manaker, MD, PhD
Charles J Lockwood, MD, MHCM
David L Hepner, MD
Deputy Editor
Geraldine Finlay, MD
Translators
蔺莉, 主任医师，教授

引言

2%以下的女性在妊娠期或围产期(即，妊娠最后1个月或产后最初几周)需收入重症监护病房(intensive care unit, ICU)[1-4]。这些患者被ICU收治的最常见指征为产后出血和高血压疾病。急性呼吸衰竭是一种罕见的妊娠期并发症。

本文将总结妊娠期和围产期急性呼吸衰竭的临床表现、鉴别诊断、最常见病因和治疗。其他妊娠相关的危重症将单独介绍。 (参见“妊娠期及围产期危重病”)

临床表现

妊娠期或围产期急性呼吸衰竭患者一般表现为呼吸窘迫[5-7]。患者常有呼吸困难，而且说话语句不完整。意识模糊、嗜睡、激越状态、发汗和/或发绀是常见表现。

大部分患者呼吸浅(潮气量小)且快(呼吸过速)，同时使用辅助呼吸肌参与呼吸运动。听诊表现因急性呼吸困难的病因不同而各异，但可能包括爆裂音、干啰音和/或哮鸣音。肺实变可能明显，表现为支气管语音、羊鸣音或耳语音增强。

初始治疗

无论急性呼吸衰竭的病因如何，其初始治疗都相同。应给予辅助供氧。首选给氧方式取决于低氧血症的严重程度。对于轻度低氧血症的患者，经鼻导管给氧即可。较为严重的低氧血症通常需要经面罩或非重复呼吸面罩给氧。应通过脉搏血氧测定连续监测患者的氧合情况。合理的目标是维持血氧饱和度大于等于95%，以使胎儿的血氧含量达到最佳水平。为使胎儿的氧合充分，母体动脉氧分压要大于70mmHg，对应的血氧蛋白饱和度是95%[8]。

                 

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-03.
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