这是一个32岁的女人的案子,Gravida3para2,前两次剖宫产,他在妊娠24+3周时到我们的急诊科就诊,抱怨严重的上腹痛向背部放射。她被诊断为严重的高甘油三酯血症并发急性胰腺炎,并由多学科团队管理,其中包括产科,胃肠病学,内分泌学,血液学,营养,ICU团队。最初,她的治疗采用保守治疗。她的口服状态为零,并以150毫升/小时的速度开始生理盐水输注,以及0.1单位/kg/小时的胰岛素输注和80ml/小时的葡萄糖(D5)。此外,她接受了奥美拉唑,美罗培南,clexane(40毫克,每日一次皮下注射),铁,维生素补充剂,和需要的镇痛药。随后,由于最初的保守医疗管理失败,患者入住ICU.在插入vascath后进行血浆置换,使用3000毫升的白蛋白5%作为替代液和口服钙。在此之后,她每天两次口服服用2克的Omacor(Omega3),以及低碳水化合物和低脂肪的饮食,来控制她的甘油三酯水平.拆卸中心线后,她的甘油三酯增加到14.3mmol/L,导致非诺贝特的起始剂量为每日一片。持续升高至16.4mmol/L,引入40mg立普妥,每天一次。在这次干预之后,她的甘油三酯水平稳定了,她的整体状况有所改善。她在25+1周时按照规定的方案出院,并在内分泌和产科诊所安排了预定的随访。妊娠36周时,她带着腹部来到急诊室,回来,和腿部疼痛。胎儿窘迫,心脏造影显示胎儿心动过速(170-180bpm),提示紧急的1类剖宫产,它没有并发症。
This is a case of a 32-year-old woman, Gravida 3 para 2, previous two cesarean sections, who presented to our emergency department at 24+3 weeks of gestation complaining of severe epigastric pain radiating to the back. She was diagnosed with severe hypertriglyceridemia complicated with acute pancreatitis and was managed by a multi-disciplinary team, which included obstetrics, gastroenterology, endocrinology, hematology, nutrition, and ICU team. Initially, conservative treatment was employed for her management. She was placed on nil per oral status and initiated on a normal saline infusion at a rate of 150 ml/hour, along with insulin infusion at 0.1 unit/kg/hour and dextrose (D5) at 80 ml/hour. Additionally, she received omeprazole, meropenem, clexane (40 mg once daily subcutaneous injection), iron, vitamin supplements, and analgesics as required. Subsequently, due to the failure of the initial conservative medical management, the patient was admitted to the ICU. Plasmapheresis was performed after the insertion of a vascath, using 3000 ml of albumin 5% as replacement fluid and oral calcium. Following this, she was prescribed Omacor (Omega 3) at a dosage of 2 grams orally twice daily, along with a low carbohydrate and fat diet, to manage her triglyceride levels. After the removal of the central line, her triglycerides increased to 14.3 mmol/L, leading to the initiation of fenofibrate at a daily dose of one tablet. With persistent elevation to 16.4 mmol/L, Lipitor at 40 mg once daily was introduced. Following this intervention, her triglyceride levels stabilized, and her overall condition improved. She was discharged at 25+1 weeks with a prescribed regimen, and scheduled follow-ups were arranged in the endocrine and obstetrics clinics. At 36 weeks of gestation, she presented to the emergency room with abdominal, back, and leg pain. Fetal distress, indicated by fetal tachycardia (170-180 bpm) on cardiotocography, prompted an urgent category 1 cesarean section, which proceeded without complications.