分娩并发症(双语).ppt

处 理 凝血功能障碍 应排除其它引起产后出血的因素 输新鲜血 补充血小板、凝血物质 并发DIC后积极处理 处 理 失血性休克 正确估计出血量及休克程度 针对病因止血的同时积极抗休克 建立有效静脉通道、补液、血浆、升压 给氧、纠正酸中毒、保护脏器功能 防治感染 预 防 加强产检，加强对高危妊娠的管理 搞好计划生育，减少人流次数 有高危因素者，加强产前检查 正确处理产程 加强产后观察，特别是产后2小时 Amniotic Fluid Embolism ,AFE羊水栓塞 1.熟悉羊水栓塞的临床表现、诊断以及处理原则 2.熟悉羊水栓塞的预防措施 3.了解羊水栓塞的病因、病理生理变化。 教 学 大 纲 Amniotic Fluid Embolism is a complex condition characterized by the abrupt onset of pulmonary embolism, shock and DIC ,renal failure or sudden death. Incidence is low Characteristic: It is hard to predict and is a dangerous obstetrics complication ,the death rate is about 70%-80% Definition Etiology The formed elements in amniotic fluid enter into maternal circulation during delivery or cesarean section . Etiology Condition: opening vessels , uterine hypertonus Inducement 诱因: rupture of uterus, laceration of cervix, placenta praevia , placental abruption Predilection factors: primiparity 初产 , allergy, precipitate labor急产, tetanic contraction 强直性宫缩 Pulmonary artery hypertension, PAH肺动脉高压 Allergic shock Disseminated intravascular coagulation, DIC Acute renal failure; ARF Pathophysiology Formed elements PAH Acute cor dextrum failure PE a RCF SE PaS TN B.S PF Clinical finding Ⅰ stage--- Shock, Respiratory and circulatory failure and hypoxemia低氧血症 Ⅱ stage--- DIC: bleeding, blood clotting disorder and then hemorrhagic shock Ⅲ stage--- Acute renal failure (ARF): oliguria少尿 and renal dysfunction 肺动脉高压：羊水有形物质形成栓子进入肺循环，阻塞小血管，血栓形成，血管痉挛，可导致右心衰 竭，休克，甚至死亡。 过敏性休克：I型变态反应、血压骤降 心肺功能衰竭 病理生理 DIC：羊水中促凝物质形成大量微血栓，消耗凝血物质，形成DIC，极易发生严重产后出血及失血性休克 急性肾衰竭：DIC及休克导致肾急性缺血 病理生理 临床表现 呼吸循环衰竭和休克 DIC引起的出血 急性肾衰竭 起病急骤、来势凶险、多在分娩过程中！！！ 症状可不典型、也可只出现部分症状！！！ Diagnosis Emergent : typical clinical manifestation Auxiliary examination Amniotic fluid components are find in blood DIC examination ECG Chest X-ray Autopsy尸解 Treatment principle 抗过敏的同时，改善低氧血症 -- 呼吸功能 保持心输出量和血压 --循环功能