羊水栓塞心脏骤停成功救治一例并文献复习

Amniotic fluid embolism followed by cardiac arrest-A case report and review of the literature

目的探讨羊水栓塞的临床特征、诊断、治疗策略和母婴预后。方法根据北京大学深圳医院收治的1例及文献报道的61例羊水栓塞患者的临床资料,对羊水栓塞的诊断、治疗方法及母婴预后进行回顾性分析。结果本例患者39岁,妊娠39周因胎膜早破入院;分娩过程二次胎膜自破,破膜后出现全身抽搐、意识丧失,随后出现心脏骤停;立即进行紧急床边剖宫产和成功心肺复苏,最终母婴痊愈出院。文献检索61例羊水栓塞患者中的前驱症状包括呼吸困难27例(44.3%)、紫绀14例(21.3%)、血压降低11例(18.0%)、精神状态改变9例(14.8%)、烦躁8例(13.1%)等;临床表现循环功能障碍52例(85.2%)、呼吸功能障碍47例(77.0%)及血液功能障碍39例(63.9%)等;使用体外膜肺氧合治疗8例(13.1%),预后均良好;死亡16例(26.2%),存活45例(73.8%),存活患者中仅3例(4.9%)有后遗症;35例(57.4%)有描述新生儿结局,其中24例(39.3%)健康,4例(6.6%)死亡,7例(11.5%)转入儿科结局未知。结论羊水栓塞主要表现为循环、呼吸衰竭及凝血功能异常,早期识别、高质量心肺复苏和及时终止妊娠是主要救治方法。

Objective To explore the clinical features,diagnosis,treatment and the outcome of amniotic fluid embolism(AFE).Methods We retrospectivly studied the clinical manifestation,diagnosis,treatment and the outcome of 1 case of AFE in Peking University Shenzhen Hospital and previous 61 literature reports.Results We reported a case of AFE followed by cardiac arrest in a 39 years old woman who was admitted to the hospital with premature rupture of membranes at 39 weeks of gestation.Cardiopulmonary resuscitation and cesarean were performed immediately.The patient and the infant were healthy.The common aura symptoms of patients with AFE included polypnea(27 cases,44.3%),cyanosis(14 cases,21.3%),drop of blood pressure(11 cases,18.0%),altered mental status(9 cases,14.8%)and dysphoria(8 cases,13.1%).The common clinical manifestations were circulatory dysfunction(52 cases,85.2%),respiratory dysfunction(47 cases,77.0%)and blood dysfunction(39 cases,63.9%).Eight cases(13.1%)used extracorporeal membrane oxygenation(ECMO),and the prognosis was excellent.Of the 61 patients with AFE,16 cases(26.2%)died and 45 cases(73.8%)survived.There are 35 cases described neonatal outcome,24 cases(57.4%)were healthy,4 cases(6.6%)were dead,7 cases(11.5%)were transferred to the neonatal intensive care unit(NICU)and the outcome was unknown.Conclusions The main manifestations of AFE are circulatory failure,respiratory failure and coagulation failure.Early identification,high quality cardiopulmonary resuscitation and opportune termination of pregnancy are the main treatment methods.