Pregnancy with bilateral tubercular pleural effusion: challenges
Pregnancy with bilateral tubercular pleural effusion: challenges
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DOI：
10.1177/0049475513517117
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发表时间：
2014-04-01
期刊：
影响因子：
0.6
通讯作者：
Gupta, Kanika
中科院分区：
文献类型：
--
作者：
Ahuja, Vanita;Gombar, Satinder;Gupta, Kanika
妊娠期肺结核（TB）模仿妊娠期间发生的一些生理变化。诊断是具有挑战性的，特别是当患者出现急性呼吸窘迫时。结核病患者胸腔积液的发生率为3-25%，大多数患者为单侧胸腔积液。我们描述了重症监护管理的一个27岁的孕妇入院与危及生命的呼吸窘迫和循环休克。尽管采取了复苏措施，但她仍有严重的代谢性和呼吸性酸中毒伴休克。此时，床旁肺部超声检查显示双侧胸腔积液，随后进行了右侧治疗性胸腔穿刺术。这导致患者的呼吸力学和血液动力学稳定。在重症监护室4周后，胸水培养结果为抗酸杆菌阳性。开始抗结核治疗，她很快从机械通气中恢复过来。床旁肺部超声检查的早期使用有助于该患者的成功治疗。
Pulmonary tuberculosis (TB) during pregnancy mimics some of the physiological changes that occur during pregnancy. Diagnosis is challenging, especially when the patient presents with acute respiratory distress. The incidence of pleural effusion in TB is 3-25% and in the majority of patients, is unilateral. We describe the intensive care management of a 27-year-old pregnant woman admitted to our hospital with life threatening respiratory distress and circulatory shock. She continued to have severe metabolic and respiratory acidosis with shock in spite of the resuscitative measures undertaken. At that point, a bedside lung ultrasonography showed bilateral pleural effusion which was followed with therapeutic thoracocentesis of the right side. This resulted in the stabilization of the respiratory mechanics and haemodynamics of the patient. The pleural fluid culture tested positive for acid fast bacilli after 4 weeks in the intensive care unit. Anti-TB therapy was started and she made a rapid recovery with liberation from mechanical ventilation. The early use of bedside lung ultrasonography was instrumental in the successful management of this patient.