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頁籤選單縮合
題名 | Suspected Ritodrine Related Acute Pulmonary Edema |
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作者姓名(中文) | 蕭旋玲; 陳琦華; 鄧新棠; 黃崇旂; | 書刊名 | 藥學雜誌 |
卷期 | 29:2=115 2013.06[民102.06] |
頁次 | 頁101-105 |
分類號 | 418.217 |
關鍵詞 | 急性肺水腫; 安胎; 擬交感神經促進劑; Acute pulmonary edema; Betamimetic agent; Premature labor; Ritodrine; Tocolytic therapy; |
語文 | 英文(English) |
中文摘要 | 本案例報告一位33歲女性於懷孕19週開始住院使用 ritodrine 注射劑安胎長達4個月,於33.5週孕程時突然發生急性肺水腫而緊急施行剖腹產順利產下胎兒,在施予氣管內管插管連接呼吸器給予氧氣治療及利尿劑使用後,症狀於8小時後緩解,1天後拔除氣管內管,病人於1週後出院。造成急性肺水腫可能之原因包括早產、長期使用 ritodrine、心跳過快、及懷孕後期體液滯留。 Ritodrine 造成之急性肺水腫其致病機轉為多重因素,正常懷孕過程即會造成心臟功能代償而提高心輸出量、血管內血液容積增加並伴隨膠體滲透壓的下降,安胎過程所使用之擬交感神經促進劑會使孕婦之心跳速度及心輸出量更進一步提升。以上多重因素交互作用之結果,可能會使得體液於肺部微血管分布失衡而造成急性肺水腫。 使用擬交感神經促進劑之前,應先排除病人是否具有潛在之心臟疾病,並且於用藥過程中規律監測病人之體液平衡、血壓、心跳速率、呼吸速度、及排尿量,並定期監測血中鈉離子、鉀離子、血糖、血紅素及血比容。 |
英文摘要 | A 33-year-old female was given parenteral ritodrine for 4 months in an attempt to suppress premature uterine contractions and developed acute pulmonary edema at the 33.5 weeks' gestation. Ritodrine was discontinued and furosemide and mechanical ventilation with high positive end-expiratory pressure (PEEP) were administered after emergent cesarean section with general anaesthesia was proceeded. The symptoms were subsided within 8 hours and the patient was extubated 24 hours post-delivery. Acute pulmonary edema on chest X-ray was resolved in 4 days and the patient was discharged 1 week later. The predisposing factors for the development of acute pulmonary edema were including premature labor, long-term use of betamimetic (beta-sympathomimetic) agent, tachycardia and rapidly increased body weight in the third trimester. With tocolytic therapy, betamimetic agents exert both chronotropic and inotropic effects on the maternal cardiovascular system and probably exacerbate the hyperdynamic and hypervolemic state of normal pregnancy. If tocolysis with betamimetic infusion is required, screening and monitoring of patients are warranted. |
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