五例羊水栓塞病例报告及文献复习

Retrospective analysis of 5 cases of amniotic fluid embolism

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。

Objective To investigate the main points of diagnosis and treatment in reducing adverse outcome of amniotic fluid embolism （AFE） by reviewing 5 cases of AFE and literature review. Methods The clinical data of the five cases of AFE were analyzed retrospectively and the related literature were reviewed. Results ① The inci- dence of AFE was about 1 in 9 000. ② There were 3 cases older than 35 years old. Prostaglandins preparation was used for one case because of the immature of cervix, ethacricline was used for one case because of the abnormality of the fetus on the request of the pregnancy women, the other 3 cases didn＇t use any of exogenous constractive prepara- tion. ③ Two cases occurred immediately after delivery, one case occurred during cesarean section, one case occurred after premature rupture of membrane with regular uterine contraction, one case occurred during the labor. ④ Two types of clinical manifestation： the initial manifestations of 3 cases were acute pulmonary artery hypertension, the initial symptoms of 2 cases was massive hemorrhage. All 5 cases had low blood pressure, hypoxemia at the begin- ning period of the disease. ⑤Outcomes： There were 1 case of maternal death, 2 cases of maternal permanent neu- rological complications, 3 eases of hysterectomy, 2 cases without hysterectomy have good longterm prognosis and 1 cases of perinatal death. Conclusions Amniotic fluid embolism is rare, pernicious and unpredictable. Rapid diagnosis and immediate treatment, especially the experienced anesthesiologist for basic and advanced life support of the suffered women are essential for the outcomes.