羊水栓塞18例临床剖析.docVIP

羊水栓塞18例临床剖析 　　【摘要】 目的 通过对18例羊水栓塞(AFE)患者的临床分析，找出其诱发高危因素，并提出防治措施。 方法 对我院1995年1月至2010年12月15年间发生的12例羊水栓塞患者及县乡转入的6例羊水栓塞患者的临床资料进行回顾性分析。 结果 产时干预(静脉滴注催产素及蓖麻油炒鸡蛋，人工剥膜)、胎膜早破、宫缩过强、瘢痕子宫、经产妇、剖宫产术等是羊水栓塞的诱发因素。本院发生的12例AFE患者中，6例救治成功，6例死亡，死亡率50%。以胸闷、憋气、呼吸困难、突发呼吸心跳骤停起病的病例抢救成功率低；以阴道出血为主要表现的病例抢救成功率高。 结论 早期诊断，及时应用肾上腺素皮质激素，尽早使用肝素，快速补充血容量及纤维蛋白质，去除致病因子及早行子宫切除术，可提高抢救的成功率；加强产时保健。保护、支持，促进自然分娩，减少不必要的医疗干预是预防AFE发生的有效措施。?? 　　【关键词】 　　羊水栓塞；产时干预；诊断；预防；死亡率；DIC 　　?お? 　　 　　Clinical analysis of 18 cases with amniotic fluid embolism 　　 　　ZHANG Xue-qin. Department of Obstetrics and Gynecology, Anyang People??s Hospital of Henan Province, Anyang 455000,China 　　?? 　　【Abstract】 Objective 　　To find out the high risk factors of amniotic fluid embolism and put forward the preventive measures by the clinical analysis of 18 cases with this disease. Methods To retrospectively analyze the clinical data of 18 cases with amniotic fluid embolism, which including 12 cases occurred in our hospital from January 1995 to December 2010 and 6 patients switched from other county and town. Results Intrapartum intervention(such as dripping oxytocin, taking scrambled eggs with castor oil, manual stripping membranes and so on), premature rupture of membranes, strong uterine contractions, scar uterus, multipara, cesarean section and so forth are the causative factors for amniotic fluid embolism. In 12 patients with amniotic fluid embolism occurred in our hospital, 6 cases of successful treatment, 6 cases of death, and with a mortality rate of 50%. Onset by chest stuffiness, breath-holding, dyspnea and sudden cardiopulmonary arrest cases rescue the low success rate, while with vaginal bleeding for the main manifestation of rescuing the high success rate. Conclusion Early diagnosis, timely applying adrenal cortical hormone, using heparin as soon as possible, quickly adding blood volume and fiber protein, removing pathogenic factors and early hysterectomies can improve the success rate of rescue.Strengthening intrapartum care, inten