目的

报道1 例产后大出血合并肺出血的产妇，结合文献复习分析其相关临床特点，以提高临床医生对孕产妇肺出血的认识。

方法

回顾性分析广州医科大学附属第三医院收治的1 例产后大出血合并肺出血患者及通过数据库检索与围产期肺出血相关的21 篇个案报道（共22 例）的临床资料。

结果

22 例患者的病因、临床表现及诊治过程不尽相同。 22 例患者中妊娠期发病12 例（54.5%），产褥期发病10 例（45.5%）。 病因由免疫因素引起的17 例（77.3%），以系统性红斑狼疮占多数；非免疫因素引起的5 例（22.7%），以凝血功能障碍多见。 临床表现以呼吸困难为首发症状者18 例（81.8%），有咯血症状者10 例（45.5%），发热者6 例（27.3%），咳嗽者7 例（31.8%）。 治疗上有19 例患者进行激素治疗，9 例进行血浆置换治疗，3 例启用了体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）治疗，且结局良好。 22 例患者妊娠结局为孕产妇死亡5 例（22.7%），胎儿丢失3 例（13.6%），继续妊娠2 例（9.2%），其余12 例（54.5%）母婴结局良好。 本例及文献检索中的2 例患者为凝血功能障碍相关的肺出血，3 例患者均在产褥期发病，合并有弥散性血管内凝血，临床表现有呼吸困难、血氧饱和度下降及气管内见血性分泌物，在治疗原发疾病基础上，部分采用血浆置换、ECMO 等支持性治疗措施，结局良好。

结论

孕产妇合并肺出血病情危重，致死率高，临床表现不典型，需加强产科医师对此类疾病的学习，提高认识，同时加强多学科间的合作。

Objective

A case of postpartum hemorrhage complicated with pulmonary hemorrhage was reported. The relevant clinical characteristics were analyzed based on a literature review to improve clinicians′ understanding of maternal pulmonary hemorrhage.

Methods

A patient with postpartum hemorrhage complicated with pulmonary hemorrhage admitted to the Third Affiliated Hospital of Guangzhou Medical University was retrospectively analyzed and the clinical data of 21 case reports related to perinatal pulmonary hemorrhage were retrieved through the database.

Results

The etiology，clinical manifestations，and diagnosis and treatment process of the 22 patients were different. Among the 22 patients， 12 patients（54.5%） developed during pregnancy， and 10 patients （45.5%） developed during puerperium. 17 cases（77.3%） were caused by immune factors， with systemic lupus erythematosus accounting for the majority.5 cases （22.7%） were caused by non-immune factors， with coagulation dysfunction most common. The first symptom was dyspnea in 18 cases （81.8%）， hemoptysis in 10 cases （45.5%）， fever in 6 cases（27.3%）， and cough in 7 cases （31.8%）.In terms of treatment，19 patients received hormone therapy，9 patients received plasma exchange therapy， and 3 patients received ECMO therapy， with good outcomes.Pregnancy outcomes included maternal death in 5 cases （22.7%）， fetal loss in 3 cases （13.6%），continued pregnancy in 2 cases （9.2%）， and the remaining 12 cases （54.5%） had good maternal and infant outcomes.This case and the 2 cases reported in the literature were pulmonary hemorrhages related to coagulation dysfunction. All three patients developed during the puerperium and had disseminated intravascular coagulation. Clinical manifestations included dyspnea， decreased blood oxygen saturation，and bloody secretions in the trachea. Based on treating the primary disease， some patients received supportive treatment measures such as plasma exchange and ECMO， and the outcome was good.

Conclusions

Pregnant women with pulmonary hemorrhage are in critical condition， with a high mortality rate and atypical clinical manifestations. It is necessary to improve obstetricians′ understanding and learning of this disease， and at the same time strengthen multidisciplinary cooperation.