羊水栓塞14例临床分析

Clinical data analysis of amniotic fluid embolism in 14 cases

目的探讨羊水栓塞的临床特点和综合防治措施。方法回顾性分析羊水栓塞患者的临床资料,通过分析高危因素、临床特点及分娩结局,探讨羊水栓塞的综合防治措施。结果石家庄市妇产医院2012年1月1日至2017年12月31日羊水栓塞发生率为1/9426(10.6/10万),经产妇比例为78.6%,产科干预6例为42.9%,且62.3%(9/14)的羊水栓塞发生在节假日。14例患者的首发症状包括:产后出血(85.7%)、休克(78.6%)、心脏骤停(50%)及呼吸困难(35.7%),而产后出血均为严重产后出血(100%),50%患者出血量≥5000mL。阴道分娩患者于胎儿娩出后即刻出现症状,剖宫产患者多于人工破膜后即刻出现症状。经过多学科团队救治,羊水栓塞的抢救成功率为85.7%(12/14),活产率为92.3%(12/13),子宫切除率为64.3%(9/14)。结论一旦怀疑羊水栓塞,应立即启动多学科抢救团队及大量输血方案。减少产科不必要的干预,建立多学科协作机制,通过培训和演练提高对羊水栓塞的认识和处置水平是羊水栓塞抢救成功的关键。

Objective To explore clinical features and comprehensive measures of treatment and prevention of amniotic fluid embolism(AFE).Methods The clinical data of amniotic fluid embolism,including risk factors,clinical features and maternal and fetal outcomes,were analyzed retrospectively to study the comprehensive measures of prevention and treatment of AFE.Results The incidence of AFE in the Obstetrics and Gynecology Hospital of Shijiazhuang was 1/9426(10.6/100000).The proportion of multiparous of AFE was 78.6%.About 62.3%(9/14)cases of AFE occurred on holidays.Initial symptoms in 14 cases included prepartum hemorrhage(85.7%),shock(78.6%),cardiac arrest(50%)and dyspnea(35.7%).The most common symptom of all cases was severe postpartum hemorrhage.The volume of postpartum hemorrhage in 50%of cases was more than 5 L.The symptoms occurred immediately after delivery in vaginal birth and immediately after artificial rupture of membrane in cesarean delivery.Thanks to multi-disciplinary work,the rate of successful rescue was 85.7%(12/14),and the rate of live birth and hysterectomy was 92.3%(12/13)and 64.3%(9/14),respectively.Conclusion We recommend that the involvement of a multidisciplinary team should be involved and massive transfusion protocol be started on consideration of AFE.It is the key to successful rescue of AFE to reduce unnecessary intervention,establish multi-disciplinary coordination and improve the recognition and management level of AFE through training and drilling.