成分输血治疗羊水栓塞所致DIC的疗效分析

Analysis of therapeutic effect of component blood transfusion on DIC caused by amniotic fluid embolism and review of literature

目的分析我院羊水栓塞患者的临床资料及诊治经过,总结羊水栓塞致弥散性血管内出血(DIC)患者输血治疗救治经验。方法回顾性分析2016年1月1日—2022年12月31日在广州医科大学附属第二医院番禺院区分娩并发羊水栓塞患者的症状、实验室辅助检查、用药诊治经过及妊娠结局。结果在6104次孕晚期分娩记录中,共发生3例羊水栓塞,高龄产妇1例、经产妇2例、多产1例。3例均并发DIC,产后出血1500~3000 mL。其中1例行子宫切除术,2例保留子宫,均抢救成功,无患者死亡。结论根据有限数据推论羊水栓塞罕见、凶险,病情进展快,多继发产后出血、DIC,主要依靠临床表现进行诊断,早期识别诊断和处理,产科快速反应团队及多学科协作,给予高级生命支持,有效止血并科学地成分输血纠正凝血功能障碍及DIC,是改善孕产妇结局的关键。

Objective To analyze the clinical data,diagnosis and treatment of patients with amniotic fluid embolism in our hospital,and to summarize the experience of blood transfusion treatment for disseminated intravascular coagulation(DIC)patients with amniotic fluid embolism.Methods From January 1,2016 to December 31,2022,the symptoms,laboratory tests,drug treatments and pregnancy outcomes of patients with amniotic fluid embolism during delivery in Panyu Hospital,the Second Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed.Results There were 3 cases of amniotic fluid embolism in 6104 late pregnancy records,accounting for 1/3 of the elderly parturients,2/3 of the multiparas and 1/3 of the prolific parturients.All three cases had DIC and postpartum hemorrhage of 1500-3000 mL.Among them,1 case underwent hysterectomy and 2 cases saved the uterus,all of which were successfully rescued without death.Conclusions Amniotic fluid embolism is rare,dangerous disease with rapid progression,often followed by secondary postpartum hemorrhage and DIC,and mainly relies on clinical manifestations for diagnosis.Early identification,diagnosis and treatment,rapid response team in obstetrics and multidisciplinary collaboration,advanced life support,effective hemostasis and scientific component blood transfusion to correct coagulation dysfunction and DIC,are the keys to improve maternal outcomes.