羊水栓塞救治的模拟演练——基于病理生理的“3M”方案

Simulation training for the treatment of amniotic fluid embolism: a pathophysiological-based “3M” approach

羊水栓塞(amniotic fluid embolism,AFE)是产科特有、罕见而凶险的并发症。其突出特点为起病急骤、进展迅猛、病死率高。因其不可预测、无法预防,要改善AFE患者的预后,就必须时刻保持高度警惕,做到早期识别,尽早启动多学科快速反应团队(rapid response team,RRT)。而如何提高多学科RRT的效能是当前面临的问题之一。经常进行多学科模拟演练是提高AFE救治成功率的主要途径。然而,目前国内外尚无公认的包括产科、新生儿科、麻醉科、重症医学科、心脏科在内的多学科模拟演练方案。本文综合现有临床研究,结合作者的临床经验,提出基于AFE病理生理的"3M"多学科模拟演练方案,即多学科(multi-disciplinary)、多靶点(multitarget)、多闭环管理(multi-PDCA loops),以期通过不断模拟培训,提高救治水平。

Amniotic fluid embolism( AFE) is a rare and life threatening obstetric emergency.Owing to its sudden onset,rapid deterioration,and high mortality,AFE is an unpredictable and unpreventable complication of maternity. To improve the prognosis of AFE patients,it is extremely necessary to achieve early recognition of symptoms, followed by immediately mobilizing the multidisciplinary rapid response team( RRT). How to improve multidisciplinary RRT team efficiency is currently a challenging topic. Regular multidisciplinary simulation training is the main approach to improve the outcome of AFE patient. However,there is currently the lack of a well-accepted multidisciplinary( including obstetrics,neonatology,anesthesiology,critical medicine and cardiology)simulation training protocol in the world. Based on clinical studies and our experience in AFE management,we propose a pathophysiology-based " 3 M" multidisciplinary simulation training program for improving AFE treatment,namely multi-disciplinary,multi-target and multi-PDCA loops.