羊水栓塞子宫成功保留9例临床分析

Clinical analysis of successful rescue of amniotic fluid eembolism1 and preservation of uterus in 9 cases

目的 探讨羊水栓塞抢救成功并保留子宫的临床特点和综合防治措施。方法 回顾性分析2010年1月至2021年10月在四川大学华西第二医院成功保留子宫的9例羊水栓塞患者的临床资料,通过分析高危因素、临床特点、抢救措施、分娩结局及再次妊娠情况,探讨羊水栓塞患者成功保留子宫的综合防治措施。结果 羊水栓塞救治成功10例,保留子宫9例,抢救成功率100%,子宫切除率10%。9例保留子宫的患者平均出血量3 069 mL,均进行了成分输血及宫缩剂治疗。其中6例使用了氨甲环酸,4例进行了气管插管,6例应用地塞米松或氢化可的松抗过敏治疗。为控制出血,宫腔球囊填塞5例,子宫动脉介入术1例。在手术中采取子宫动脉结扎术6例,子宫捆绑术3例,子宫背氏缝合术2例。电话随访保留子宫的羊水栓塞患者均表示预后可,但88.9%的患者对再次妊娠产生了恐惧心理,再次妊娠率0%。结论 重视孕产妇每一个特殊的症状及体征,早期识别并尽快采取急救措施,尽早纠正弥散性血管内凝血,启动大量输血方案,在病情允许的情况下可尝试使用宫腔球囊填塞术、子宫动脉介入术等保留患者子宫。

Objective To explore the clinical characteristics and comprehensive prevention and treatment measures of successful rescue of amniotic fluid embolization and retention of uterus.Methods Clinical data of 9 patients with amniotic fluid embolism who had successfully preserved uterus in West China Second Hospital of Sichuan University from January 2010 to October 2021 were retrospectively analyzed.By analyzing the high-risk factors,clinical characteristics,rescue measures,delivery outcomes and second pregnancy,the comprehensive prevention and treatment measures for successful uterine preservation of patients with amniotic fluid embolism were discussed.Results Amniotic fluid embolism was successfully rescued in 10 cases were successfully treated and 9 cases of uterus were saved,the success rate of rescue was 100%,the hysterectomy rate was 10%.The 9 patients with uterine reservation had an average blood loss of 3069 mL and were treated with component blood transfusion and uterine contractions.6 of them were treated with tranexamic acid,4 with endotracheal intubation,and 6 with dexamethasone or hydrocortisone. In order to control bleeding,5 cases ofuterine balloon packing and 1 case of uterine artery intervention were performed. Uterine artery ligation was performed in 6 cases,uterine ligature in 3 cases and dorsi suture in 2 cases. During telephone follow-up,the prognosis of patients with amniotic fluid embolismwho retained uterus was satisfactory, but 88.9% of patients had fear of repregnancy, and the rate of repregnancy was 0%.Conclusion Attention should be paid to every special symptom and sign of pregnant women,early recognition and emergency treatmentshould be taken as soon as possible,DIC should be corrected as fast as can,massive blood transfusion program should be initiated,anduterine balloon tamponade and uterine artery intervention should be attempted to preserve the uterus of patients if the condition permits.