初产妇并发反常声带运动及胎盘早剥导致急诊剖宫产的紧急气道处理：一例病例报告

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中文摘要

背景 反常声带运动障碍（PVFM）是一种罕见的疾病，表现为发作性上气道阻塞，导致反复喘鸣和呼吸窘迫。关于其在妊娠期间的表现、影响和后果的数据有限。在本报告中，我们介绍了一例23岁初产妇，已知患有PVFM并反复喘鸣，她出现急性呼吸窘迫需要气管插管，随后在重症监护室进行了急诊床旁剖宫产，术中偶然发现胎盘早剥。病例报告 一名23岁初产妇，已知有PVFM病史，接受了双侧声带肉毒毒素注射。出院一周后因反复喘鸣再次入院，对症治疗暂时缓解。然而，她随后出现急性呼吸窘迫，需要插管。之后因胎心音不可靠，在重症监护室（ICU）需要紧急床旁剖宫产，术中偶然发现胎盘早剥。结论 本病例强调了妊娠相关的解剖和生理气道变化可能加重PVFM，给非手术室环境中的紧急气道管理带来挑战。它还提示急性加重的慢性PVFM发作与胎盘早剥之间存在关联。我们得出结论，患有PVFM的妊娠患者必须密切监测，并被认为比一般人群有更高的困难紧急气道和可能导致胎盘早剥的母体呼吸窘迫风险。

英文摘要

BACKGROUND Paradoxical vocal fold motion disorder (PVFM) is a rare condition consisting of episodic upper airway obstruction, resulting in recurrent stridor and respiratory distress. Limited data exists regarding its presentation, implications, and consequences during pregnancy. In this report, we present the case of a 23-year-old primigravida woman with known PVFM and recurrent stridor who developed acute respiratory distress requiring endotracheal intubation, followed by emergency bedside cesarean delivery, during which an incidental placental abruption was identified. CASE REPORT A 23-year-old primigravida woman with known history of PVFM underwent bilateral vocal fold botulinum toxin injections. She was re-admitted one week after being discharged with recurrent stridor, which temporarily responded to symptomatic management. However, she subsequently developed acute respiratory distress necessitating intubation. She then required emergency bedside cesarean section in the intensive care unit (ICU) for non-reassuring fetal heart tones, in which a placental abruption was incidentally discovered. CONCLUSIONS This case highlights the potential for pregnancy-related anatomic and physiologic airway changes to exacerbate PVFM, creating challenges for emergency airway management in non-operating room settings. It also suggests an association between acute-on-chronic PVFM episodes and placental abruption. We conclude that pregnant patients with PVFM must be monitored closely and considered to be at increased risk for difficult emergency airways and maternal respiratory distress than can lead to placental abruption.