分娩中羊水栓塞的成功处置:一例临床危重病例报告及文献复习

Amniotic Fluid Embolism Managed with Success during Labour: Report of A Severe Clinical Case and Review of Literature

羊水栓塞（amniotic fluid embolism,AFE）是一种进展迅猛的严重分娩并发症,其发病率为2/100 000～6/100 000,产妇病死率为61%～86%,新生儿存活率为70%。报告1例极重症羊水栓塞病例情况,并对既往文献进行复习综述。该病例为33岁经产妇,患有妊娠期贫血,在分娩过程中发生AFE。首发症状为急性呼吸衰竭,在此情况下行产钳助产。初诊为AFE,转入手术室抢救。患者失血过多并出现凝血功能障碍,因大出血（约3 000 m L）行子宫次全切除术,而后持续输入血制品。患者术后转至重症监护病房（ICU）继续治疗,因慢性肾功能衰竭接受持续性床旁血液滤过,而后间断行血液净化治疗。治疗3个月后病情好转出院,新生儿存活,未遗留神经系统异常。患者现为慢性肾功能不全,定期门诊透析治疗。

Amniotic fluid embolism（AFE） is widely known as a disastrous rapid-progressing intrapartum complication.The incident ranges from 2/100 000 to 6/100 000. The mortality rate reaches 61% —86%. Neonatal survival is reported at 70%.We describe a case of severe AFE in our practice and review the relevant documents. A 33-year pluripara developed amniotic fluid embolism during labour. The mother identified as gestational anemia when came to our hospital with acute respiratory failure to be her initial symptom. A forceps delivery was performed. She showed extreme blood loss complicated by disseminated coagulopathy. A subtotal hysterectomy was performed due to approximately 3000 m L bleeding. Aggressive management was practiced with continuous transfusion of blood products. Haemodialysis was performed because of chronic renal failure after her being transmitted to ICU. The patient had been treated for 3 months and discharged from hospital with an improved condition and a survived baby without neurological damage. The patient receives dialysis regularly due to chronic renal failure.