Page 12 - 麻醉与监护论坛2015年第7期

Review of Diagnosis and Treatment for a Cardio-pulmonary
Resuscitation (PCR) Patient with HELLP Syndrome after
Cesarean Section

——The discussion on clinical thinking of post-resuscitation syndrome

Yan Zhao, Qing Song, Fei-hu Zhou, Hong-jun Kang, Xin Hu

Critical Care Medicine Department, Chinese PLA General Hospital, Beijing 100853, China

Abstract

Background: To discuss the clinical characteristics and the key points about the diagnosis and therapy for post-resuscitation syndrome (PRS) and
aim to improve its survival rate and prognosis.

Methods: A retrospective analysis was performed on clinical data of a PRS patient in our hospital.
Results: This patient was admitted for menolipsis for 30+4 weeks, elevation of blood pressure for 6 weeks and epigastric pain for 1 day, and the
intrauterine pregnancy(30+4 weeks ), severe pre-eclampsia and HELLP syndrome were made. The emergency cesarean section with general anesthesia
was performed and transferred to ICU after operation due to anuria. During the process of continuous renal replacement therapy (CRRT), the patient
suddenly suffered from ventricular fibrillation for two times and recovered sinus rhythm after CPR but still in a coma. Brain protection was carried out
besides administration of dexamethasone, dopamine and magnesium. Then the patient recovered consciousness after 3 days except extremities muscle
strength which was defined grade 0 and received the treatment of neurotrophic drugs and acupuncture. After a total of 46 days treatment and 3 months
follow-up, the patient muscle strength fully recovered to normal.
Conclusion: Brain protection and maintaining the stability of hemodynamics with compositive means maybe the key role in the treatment of PRS,
which has important significance for the improvement of its prognosis.
Key Words: Cardiopumonary resuscitation; Post-resuscitation syndrome; Multiple organ dysfunction syndrome; Cerebral injury; Prognosis
Corresponding Author: Yan Zhao, E-mail: qiqi9621@qq.com

Post-resuscitation syndrome (PRS) is a pathology on PRS and the value of improvement the prognosis by
process of multiple organ dysfunction syndrome establishing overall clinical thinking.
(MODS) or multiple organ failure (MOF) occurring
after the restoration of spontaneous circulation caused I. Case information
by cardiopulmonary resuscitation (CRP). The process
happens when cardiovascular function and hemodynamics The patient was female, 39 years old. She was
disorder, and a variety of pathogenic factors, for instance, admitted for menolipsis 30+4 weeks, with elevation of
tissue hypoxia, hypoperfusion, reperfusion injury, blood pressure for 6 weeks and epigastric pain for 1 day.
accumulation of metabolites and coagulation disorder —— After pregnancy for 24 weeks, high blood pressure (140
cause functional impairment to the tissue cells, so that ~150/90~100mmHg) was found in pregnant routine
systemic inflammatory response syndrome (SIRS) occurs physical examination without formal treatment. 1 day
further. Currently, numerous researches and guidelines are before admission, the patient experienced epigastric pain
focusing on how to carry out CPR and establish artificial with nausea and vomiting 20 min after dinner suddenly.
airway incipiently, considering defibrillation and advanced Vomit was stomach contents without diarrhea symptom.
life support, and less considering about the existence The patient took omeprazole 20mg orally on her own, but
and overall handling of PRS. Despite the great technique symptoms got worse, then she went to a nearby hospital for
advance of CPR in recent years and the improvement of treatment, measuring blood pressure for 130/100mmHg,
prognosis in patients after resuscitation, the mortality rate given 654-2 10mg intramuscular injection. Symptoms
of patients with successful resuscitation still reaches 65% did not relieve obviously, so she was transferred to our
to 75% as reported in the literature .[1-4] According to a hospital. Physical examination: The patient was generally in
retrospective analysis for one case of PRS clinical data, the good health with heart rate of 88/min and blood pressure
paper illustrates the clinical significance of the emphasis of 144/90 mmHg. Heart and lung were normal by the
auscultation. Right upper abdomen was mild tenderness

LaboratoryRaenvdieCwlinaincdalCInMvEesLteigcatutiroen 2428 FAM 2013 Jan/Feb Vol.20 Issue 1