血液净化救治重症休克孕妇合并重度代谢性酸中毒1例  

Rescue of severe metabolic acidosis in a pregnant woman with severe shock by blood purification

作　　者：杨海玲 杨顺权 杨长华 吴海燕 张鑫 龙艳燕 徐雪 袁仕金 唐艳 Yang Hailing;Yang Shunquan;Yang Changhua;Wu Haiyan;Zhang Xin;Long Yanyan;Xu Xue;Yuan Shijin;Tang Yan(Department of Critical Care Medicine,Qiandongnan Miao and Dong Autonomous Prefecture 556500,Guizhou,China;Department of Hemodialysis Room,Sansui County People's Hospital,Qiandongnan Miao and Dong Autonomous Prefecture 556500,Guizhou,China;Department of Critical Care Medicine,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China)

机构地区：[1]三穗县人民医院重症医学科,贵州黔东南苗族侗族自治州556500 [2]三穗县人民医院血透室,贵州黔东南苗族侗族自治州556500 [3]贵州医科大学附属医院重症医学科,贵州贵阳550004

出　　处：《中国中西医结合急救杂志》2022年第1期98-100,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金培育基金(gyfynsfo2020-26);吴阶平医学基金会临床科研专项资助基金(320.6750.18001);贵州省科技计划项目(2021-090)。

摘　　要：目的 总结血液净化救治危重症患者的经验.方法 分析血液净化用于治疗急性肾损伤等病情复杂且特殊的重症患者的疗效.结果 三穗县人民医院于2020年10月13日收治1例重度代谢性酸中毒且影响循环引起严重休克合并急性肾损伤的孕产妇,患者入院1 d前出现严重腹泻,恶心、呕吐数次,入院12 h后出现意识障碍和休克,给予气管插管、呼吸机辅助呼吸,扩容补液联合血管活性药物维持血压,并给予连续性肾脏替代治疗(CRRT).持续血液净化30 h后患者重度酸中毒得到纠正,脱离呼吸机,胎儿娩出后行子宫动脉栓塞术,术后患者病情逐渐平稳,于11月4日出院.结论 本例患者积极使用血液净化治疗最终救治成功,为治疗此类患者提供了很好的经验.Objective To summarize the experiences of treatment for critically ill patients with blood purification.Methods The efficacy of blood purification in the treatment of acute renal injury and other severe patients with complex and special conditions were analyzed.Results On January 13,2020,a pregnant woman with severe metabolic acidosis affecting circulation,causing severe shock complicated with acute renal injury was treated in Sansui County People's Hospital.The patient had severe diarrhea,nausea and vomiting for several times 1 day before admission,and conscious disorder and shock occurred 12 hours after admission.Immediately endotracheal intubation,ventilator assisted respiration,volume expansion and rehydration comhined with vasoactive drugs to maintain blood pressure and continuous renal replacement therapy(CRRT)were given to the patient.After continuous blood purification for 30 hours,the patient's severe acidosis was corrected and separated from the ventilator.Uterine artery embolization was performed after fetal delivery.The patient's condition gradually stabilized and was discharged on November 4.Conclusion In this patient,the blood purification treatment was used actively,and the final therapeutic result was successful,which provided a good experience for such patients.

关 键 词：血液净化 重症孕妇 代谢性酸中毒 高钾 休克 

分 类 号：R47[医药卫生—护理学]