14例羊水栓塞产妇救治实践回顾分析

Retrospective Analysis for Treatment of 14 Parturients with Amniotic Fluid Embolism

目的提取救治羊水栓塞(amniotic fluid embolism,AFE)产妇的成功经验,为临床提高羊水栓塞产妇救治水平提供实践参考。方法对2007-01/2015-12月作者医院14例产妇发生围产期AFE的临床救治资料进行回顾性分析,同时进行文献循证。结果本组AFE产妇14例(重型10例),其中单胎12例,双胎2例;发生于剖宫产9例(64.29%),阴道分娩5例(35.71%);以急性肺动脉高压为首发症状者11例(78.57%),以产后出血凝血功能障碍为首发症状者3例(21.43%);成功救治12例(85.71%),死亡2例(14.29%),子宫切除2例(14.29%);娩(剖)出活婴15例,死胎1例。结论 AFE临床发生率虽低,但绝非罕见;临床症状是目前AFE早期诊断、及时救治的重要依据;增强对AFE的防范意识是成功救治AFE的前提条件;尽早纠正低氧血症及心肺复苏是成功救治AFE的有效措施;尽早抗休克是成功救治AFE的关键环节;早期处理弥漫性血管内凝血(disseminated intravasculalk coagulation,DIC)是成功救治重症AFE的重要保证;实施产科有效止血措施是成功救治AFE的重要途径;多学科协作是成功救治重症AFE的必要条件。

Objective To summarize the experiences of rescue parturients with amniotic fluid embolism（AFE）and research the measures to increase success rate.Methods The clinical data and research measures in 14 AFE parturients from January 2007 to December 2015 were retrospectively analyzed and evaluated with evidence-based medicine.ResultsIn the 14 AFE cases（10 severe cases）,12 cases for sigle birth and 2 cases for twins.Nine cases underwent cesarean section（64.29%）and 5 cases underwent vaginal delivery（35.71%）.The initial symptoms in 11 cases was acute pulmonary hypertension（78.57%）and that in5 cases was postpartum hemorrhage coagulation disorders（21.43%）.Twelve parturients were successfully rescued（85.71%）and 2 died（14.29%）;15 live fetus were delivered and 1 died.Two parturients were accepted hysterectomy（14.29%）.Conclusion AFE has low incidence,but it is not rarely seen.Clinical symptoms provide an important basis for early diagnosis and timely treatment of AFE.The measures of prevention AFE are cultivating precaution consciousness.Four main measures rescue AFE successfully,including correct hypoxemia,cardiopulmonary resuscitation（CPR）,anti-shock,early treatment of disseminated intravasculalk coagulation（DIC）,effective hemostasis in obstetrics and multi-disciplinary treatment.