围术期急性羊水栓塞11例诊治分析

Analysis of 11 cases of perioperative acute amniotic fluid embolism

目的通过探讨围术期羊水栓塞的发生原因及诊治措施,提高对羊水栓塞的诊断、预防及抢救水平。方法收集1995年5月-2011年8月围术期羊水栓塞患者11例,进行回顾性分析。结果 11例羊水栓塞患者中,进入手术室尚未进行麻醉出现羊水栓塞的患者2例,剖宫产术中出现羊水栓塞的患者9例。有胸闷、呼吸困难、呛咳等肺动脉高压症状者6例,确诊弥散性血管内凝血(DIC)者5例,经抢救治疗后,6例症状缓解,4例切口及阴道出血不止,行子宫全切除或次全切除术。抢救无效死亡1例,抢救治愈10例,死亡率9.09%。结论及时、正确的诊断,并采取合理、有效的抢救措施是提高抢救成功率的关键。

Objective To explore the causes and treatment of perioperative amniotic fluid embolism,and improve the diagnosis,prevention and rescue level of amniotic fluid embolism. Methods Clinical data of 11 patients with perioperative amniotic fluid embolism from May 1995 to August 2011 were collected and retrospectively analyzed. Results 11 cases of amniotic fluid embolism patients into the operation room had not yet performed anesthesia in patients with amniotic fluid embolism in2 cases; 9 cases of amniotic fluid embolism occurred in patients with cesarean section. Chest tightness,dyspnea,choking cough and pulmonary arterial hypertension symptoms were occurred in 6 cases,and 5 cases were diagnosed diffuse intravascular coagulation（ DIC）. After treatment,6 patients relieved the symptoms,and 4 cases of incision and vaginal bleeding,and then uterine subtotal or time total resection. Died 1 case,and rescue cure in 10 cases,the mortality rate was 9. 09%. Conclusion Timely and correct diagnosis,taking reasonable and effective rescue measures is the key to improve the success rate of rescue.