Allergic pulmonary inflammation is associated with respiratory failure in maternal anesthesia management.

Maternal, 34 years old, 50kg, G2P1, pregnant 32 plus 5 weeks, due to "repeated coughing cough sputum can not lie flat for more than 3 months" hospitalization, preoperative general condition is poor, did not see obvious lip cyanosis, RR28 times / minute, HR127 times / minute, BP132 /84mmHg, body temperature 37.4 degrees C.
was diagnosed with "allergic pulmonary inflammation, scarred uterus" after examination and medical history.
due to the strengthening of the urinary contraction and breathing difficulties aggravated, then emergency caesarean section.
past "allergic pulmonary pulmonary inflammation" medical history of more than 9 years, there have been leather factory work experience, organic dust inhalation history, accompanied by thyroid decompression history of more than 10 years.
physical examination: Shenqing, poor spirit, double lung breathing sound thick, fine wet tone, heart rhythm, valve stethoscope area unheard and pathological noise, double lower limb moderate depression edema.
: Lung function tips to limit the main hybrid breathing dysfunction, severe damage.
ESR56mm/h, CRP38.80mg/L, albumin 26.9g/L, WBC9.41 x 109/L, NEU83.3%.
,ECG,。
the mother after entering the room is sitting at the end of breathing, shortness of breath, RR30 times / minute, and accompanied by coughing, coughing sputum and wheezing and other symptoms, listening to the sound of breathing thick.
routine monitoring ECG, SPO2, open outer veins, control rehydration volume and rehydration speed, mask pure oxygen absorption, the bottom of the left artery puncture tube, there is invasing artery monitoring.
HR132 times/min, SpO2 88% (no oxygen absorption), IBP 126/63mmHg, paO256mmHg, PaCO230mmHg, pH7.47.
In view of the severe maternal wheezing and cough, anesthesia is an epidural anesthesia, the use of side-lying 60 degrees (below the position, cough breathing difficulties aggravated, inability to bear), L2-L3 vertebral gap puncture tube, puncture tube process is smooth, given an experimental dose of 2% Lidokain 3 ml immediately after half-bed 60 degrees, while giving electric blanket and warm air machine to implement insulation, 5min after 2% ml, about 10min, leg and foot numbness, test anaesthetic plane T12 below, again add 0.75% rodin 5 ml, about 5min after anesthesia plane up to T10, re-review arterial blood gas tips: PO2 70mmHg, PCO2 29mmHg, pH7.45, and instruct the surgeon disinfection napkin surgery, anesthesiologists and neonatologists at the same time to prepare newborns.
preoperative static push 40mg of sodium methamphetone sodium sodium, about 6min after the operation began to remove the fetus, Apgar8 to 10 minutes, the fetus is in good condition, sent to the neonatal intensive care unit for observation, while the maternal static push pyridosin 10mg, slow drip hypoclytic uterine, about 20min after a second review of arterial blood gas PO2110.5mmHg, PCO231 .20mmHg, pH7.47, fetal removal of 15min after the maternal cough significantly reduced, to explore the uterus and pull the peritonum when a little discomfort, inoperative BP basically maintained at 130 to 110/80 to 55 mmHg, intraoperative supplement sodium chloride 500ml, urine volume 300ml, bleeding volume 200ml.
48h analgesia after surgery using Shufenthani 100mg and dizosin 10mg and Ondansjong 8mg, surgery to remove the epidural catheter into the ICU.
postoperative review of high-resolution CT prompt double pulmonary diffuse lesions, continue to fight infection, sputum cough, oxygen absorption treatment, 3d symptoms improved, transferred to the general ward.
The discussion of allergic pneumonia is a special diffuse pulmonary disease, also known as exogenous allergic pulmonary pulmonary inflammation (EAA), mainly susceptible people repeatedly inhale a variety of antigenic organic dust and low molecular chemicals caused by an immune response leading to a group of clinical syndrome.
clinical manifestations of cough, coughing and wheezing and other symptoms, serious can lead to palpitations and type I. respiratory failure, often acute or subacute disease.
treatment mainly to disengage from allergens and hormone therapy, the general prognostication is relatively good.
diagnosis is mainly based on the patient's exposure history, symptoms, lung high-resolution CT, lung function and laboratory examination, if necessary, lung puncture identification diagnosis, this case of maternal according to the medical history and examination in line with the EAA diagnosis.
EAA clinical incidence is rare, CT shows diffuse glass-like changes, even interstital fibrosis, lung function is shown as restrictive breathing dysfunction accompanied by a reduction in dispersion function.
Some physiological changes in the late stages of pregnancy, such as increased blood volume, hormonal changes, enlarged uterus, decreased lung function and increased oxygen consumption, led to the acute onset of allergic alfusitis, which was previously in the chronic period, so that the mother coughed up sputum, sitting and even breathing failure serious complications, induced uterine contraction and termination of pregnancy, resulting in premature birth, even endangering maternal and child safety, fetal asphyxia, may require rescue and postoperative treatment back to the neonatal intensive care unit.
reports on the EAA literature are not uncommon, but cases of maternal merger serious EAA are less reported, and anaesthetic management is even less.
the implementation of anesthesia is based on maternal symptoms and pathophysiology to deal with, caesarean section of the preferred mode of anesthesia is intravertebral anesthesia, there is an emergency critical or intravertebral tube can not be implemented in the implementation of the full hemp.
In this case, the maternal hearing is not significantly abnormal, so first consider intravertebral anesthesia, but the mother can not withstand conventional body puncture, need to find a suitable puncture position to avoid aggravating maternal symptoms, will inevitably increase the difficulty of puncture, and even ultrasound-guided puncture.
total leprosy tube intitation stimulates a large increase in sputum, resulting in increased obstruction of the trachea and infection, and even mechanical damage to the lungs, serious ARDS, difficulty pulling the tube, prolonging the ICU hospital stay and so on.
Waist hemp effect is fast, block perfection, high rate of low blood pressure, and even respiratory failure aggravation, to be implemented, then preventive benzene or epinephrine pump injection, or heavy weight lumbar drug slowly push injection, to avoid a large number of rapid rehydration.
an epidural anesthesia is slow to take effect, may be incomplete, the anaesthetic plane is easier to control, blood pressure and breathing effects are small.
, in view of comprehensive consideration, the mother implemented epidural anesthesia, the mother used a half-bedroom more than 60 degrees position, relatively with, punctures smoothly.
if the mother is obese, unable to cooperate, the puncture position is difficult to implement, or the mother's condition is critical, whole hemp is the last option, but the risk and complications increase significantly.
because of the special position, the anaesthetic plane is difficult to rise, and finally up to T10 to start surgery, pulling the peritonum or internal organs when the main complaint a little discomfort indicates that the epidural anesthesia there is imperfection.
cold is a common adverse reaction in caesarean section surgery, especially intravertebral anesthesia, the maternal perioperative period using temperature protection measures, no cold war occurred, to avoid the aggravation of symptoms of breathing difficulties.
fetal removal, the maternal cough decreased, breathing was relatively smooth, and PaO2 improved significantly.
to prevent and control fetal removal, the amount of back blood increased, the risk of pulmonary edema increased, to limit rehydration and preventive treatment of a small amount of rapid urine and other measures.
, allergic albbisitis is associated with respiratory failure of maternal reasonable anaesthetic option selection and management is the key to the success of surgery and postoperative recovery.
in case of non-emergency or taboo, first of all intravertebral anesthesia, try to avoid the risk of total hemp, find the right puncture position and surgical position, reduce the symptoms of breathing difficulties.
, fully oxygen and insulation, improve PaO2, avoid chills.
, strengthen monitoring, maintain circulation and respiratory stability, such as arterial monitoring and arterial blood gas analysis, control infusions, avoid pulmonary edema, treatment if necessary, and prepare newborns for rescue.
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