五例羊水栓塞病例报告及文献复习

发布时间：2018-01-22 00:28

本文关键词： 羊水栓塞生命支持孕产妇死亡弥散性血管内凝血　出处：《中国妇产科临床杂志》2015年01期 　论文类型：期刊论文

【摘要】：目的通过5例典型羊水栓塞病例及文献复习,分析探讨减少羊水栓塞病例不良结局的诊治要点。方法回顾性分析5例羊水栓塞病例的诊治、结局及相关文献复习。结果 1 16年间羊水栓塞的发生率约1/9 000;2高龄孕妇3例;应用前列腺素制剂改善宫颈条件和依沙吖啶引产各1例;其余3例未使用外源性宫缩剂;3发生于产后即刻2例、剖宫产术中1例、胎膜早破有规律宫缩但尚未临产1例、依沙吖啶引产产程中1例;4临床表现:两种类型,突发的急性肺动脉高压为首发症状者3例(3/5),产后出血凝血功能障碍首发症状者2例(2/5);均出现低血压、低氧血症;5结局:孕产妇死亡1例(1/5),永久性神经系统并发症2例(2/5),子宫切除3例(3/5)。未切除子宫远期预后良好2例(2/5)。围产儿死亡1例(1/5)。结论羊水栓塞罕见、凶险、难以预防,快速诊断和处理,特别是有经验的麻醉医生及时到场生命支持,是改善孕产妇结局的关键。
[Abstract]:Objective to analyze the diagnosis and treatment of 5 cases of amniotic fluid embolism and review the literature. Methods the diagnosis and treatment of 5 cases of amniotic fluid embolism were retrospectively analyzed. Results the incidence of amniotic fluid embolism in the past 16 years was about 1/9 000; (2) 3 old pregnant women; Prostaglandin preparation was used to improve cervical condition and to induce labor by ethacridine in 1 case each. The other 3 cases did not use exogenous uterine contractions. (3) 2 cases occurred immediately after delivery, 1 case in cesarean section, 1 case in premature rupture of membranes but not yet in labor, and 1 case in labor induced by ethacridine; 4 Clinical manifestations: two types: acute pulmonary hypertension was the first symptom in 3 cases (3 / 5), and postpartum hemorrhage in 2 cases (2 / 5). All had hypotension and hypoxemia. (5) outcome: 1 case died of pregnancy and 1 case had 1 / 5 mortality, and 2 cases had permanent neurological complications (2 / 5). There were 3 cases of hysterectomy and 3 cases of hysterectomy. The long term prognosis of unresected uterus was good in 2 cases. One case died of perinatal death. Conclusion amniotic fluid embolism is rare, dangerous, difficult to prevent, rapid diagnosis and treatment. In particular, the presence of experienced anesthesiologists in life support is the key to improving maternal outcomes.
【作者单位】：北京大学第一医院妇产科;首都医科大学密云教学医院妇产科;
【分类号】：R714.468
【正文快照】： 羊水栓塞(amniotic fluid embolism,AFE)是在分娩过程中或产后即刻发生的严重的并发症,主要表现为缺氧、血压下降、呼吸循环衰竭甚至心跳骤停、产后出血等一系列类似于严重过敏反应症候。发生率1?8 000~1?80 000,死亡率高达60%。虽然罕见,但在世界范围内羊水栓塞是孕产妇死亡

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