肺栓塞孕产妇死亡病例56例临床分析

Clinical Analysis of 56 Cases of Maternal Death Caused by Pulmonary Embolism

[目的]探讨孕产妇发生肺栓塞的诱因、诊治和预防。[方法]回顾性分析湖南省2006年10月1日至2012年9月30日56例因肺栓塞引起的孕产妇死亡病例资料。[结果]因肺栓塞所致孕产妇死亡人数占孕产妇死亡总数的4．71％（56/1190）；发生在产前7例，产时2例，产后43例。另外，发生在宫腔镜下清宫术中2例，剖宫流产术中1例，早孕人流术后1例。其中24例发生在产后48 h内，占产后死亡总数的55．8％（24/43）；产时及产后死亡病例中剖宫产39例，阴道产6例；依据临床表现联合C T 诊断肺栓塞4例，尸检确诊1例，余均依据临床表现死后推断；在抢救措施方面，仅3例给予了抗凝治疗。[结论]重视孕妇肺栓塞高危因素的筛查，严格控制剖宫产指征，规范肺栓塞的诊断并掌握急救方法，重视深静脉血栓的预防和筛查，是预防和降低因肺栓塞所致孕产妇死亡的关键。

[Objective] To explore the incentives ,diagnosis ,treatment and prevention of maternal pulmo-nary embolism .[Methods]Clinical data of 56 cases of maternal death caused by pulmonary embolism in Hunan province from Oct .2006 to Sept .2012 were analyzed retrospectively .[Results]The maternal deaths caused by pulmonary embolism accounted for 4 .71% （56/1190） of total maternal deaths .Seven cases occurred before de-livery ,and 2 cases occurred during delivery ,and 43 cases occurred after delivery .Moreover ,2 cases occurred in hysteroscopic curettage ,and 1 case occurred in cesarean abortion ,and 1 case occurred after abortion .A-mong 43 postpartum cases ,24 cases（55 .8% ） occurred within 48 hours after delivery .In 45 intrapartum and postpartum cases ,39 cases underwent cesarean section and 6 cases underwent vaginal delivery .Four cases were diagnosed as pulmonary embolism through clinical manifestations and CT ,and 1 case was confirmed through autopsies ,and the other cases were inferred after death through clinical manifestations .Only 3 pa-tients were given anticoagulant therapy in the rescue measures .[Conclusion]The screening of high risk factors of maternal pulmonary embolism should be emphasized .The indicators of cesarean section should be controlled strictly .The diagnosis of pulmonary embolism should be standardized and the first aid should be mastered . The prevention and screening of deep vein thrombosis should be paid attention and is the key to prevent and re-duce maternal death due to pulmonary embolism .