羊水栓塞的发病机制及诊治进展

The Progess in Pathogenesis,Diagnosis and Treatment of Amniotic Fluid Embolism

目前认为羊水栓塞是白三烯、前列腺素、血栓素等物质进入母血循环引起的“妊娠过敏样综合征”。因而 ,促使肺支气管痉挛、血小板聚集、血管内凝血 ,主要表现为左心功能障碍导致的肺动脉压轻到中度增高。除临床症状、体征外 ,早期诊断依靠中心静脉及肺动脉插管吸出物中找到胎儿鳞状上皮细胞或碎屑及右心导管插入术获得血流动力学资料 ,免疫组化测定肺循环中的 ET- 1浓度及母亲血清中的 sialy1Tn抗原的水平。羊水栓塞的确切诊断 ,主要是尸检发现肺血管内有胎儿细胞成分。羊水栓塞的治疗 ,主要是改善低氧血症 ,防止 ARDS发生 ,保护心肌 ,抢救休克 。

Recent studies suggest that AFE should be described as “anapohylactoid syndrome of pregnancy” caused by leukotrienes,prostaglandins,and thromboxanes etc entering the maternal circulation.So they bring about bronchiospasm,platelet aggregation,intravascular coagulation.The major symptomes are from mild to moderate elevations in pulmonary artery pressure followed by left heart failure.Besides clinical symptomes,the early diagnosis is dependent on the finding of fetal squamous cells and debris in maternal blood aspirated from the central venous of pulmonary arterial catheter,hemodynamic data from right heart catheterization,using immunohistochemical methods to detect endothelin 1 levels in pulmonary circulation or sialy1.Tn antigen levels in maternal serum,the diagnosis of AFE is dependent on autopsy,the treatment of AFE is used for the purposes of relieving hypoxia,preventing ARDS,rescuing the patient suffering from shock,maintaining cardiac output and preventing intravascular coagulation.