羊水栓塞8例临床剖析.docVIP

羊水栓塞8例临床剖析 　　[摘要] 目的 探讨羊水栓塞的诊治经验，旨在提高羊水栓塞的抢救成功率。 方法 回顾性分析2004年1月～2014年1月我院诊治的羊水栓塞8例患者的临床资料。年龄18～44岁，平均（27.6±3.7）岁。孕周27～43 周。其中初产妇1例，经产妇7例。所有AFE患者均予以地塞米松20 mg静注，面罩加压给氧，开通多条静脉通道；对呼吸、循环系统症状明显者给予阿托品0.5～1.5 mg及氨茶碱250 mg，解除肺动脉高压。其中4例经上述处理后症状消失，余病情无缓解者继续给予地塞米松20 mg静脉注射，同时进行抗休克治疗。 结果 8例AFE中，胎膜早破2例，使用催产素引产3例，剖宫产2例，其他1例。2例心肺复苏成功后未发生DIC。阴道出血量最少1000 mL，最多8000 mL，平均4500 mL。所有患者均存活，患者无一例出现羊水Ⅲ°粪染。 结论 羊水栓塞病情凶险，其治疗的三个重要方面是改善低氧血症、保持心输出量和血压、防止血管内凝血，要求临床医生要严格遵守医疗操作常规，努力提高产科技术，同时加强各科合作，才能提高抢救的成功率。 　　[关键词] 羊水栓塞；羊水粪染；死亡 　　Clinical analysis of 8 cases amniotic fluid embolism 　　YANG Lijie1 ZHANG Zixin2 　　1.Jiamusi Maternal and Child Health-Care Hospital in Heilongjiang Province，Jiamusi 154002，China；2.Hegang Mining Group Maternity and Infant Hospital， Hegang 154100，China 　　[Abstract] Objective To investigate the experience of diagnosis and treatment of amniotic fluid embolism， aims to improve the rescue success rate for amniotic fluid embolism. Methods Retrospective analyzed the clinical data of 8 patients with amniotic fluid embolism in our hospital from January 2004 to January 2014. Aged 18 to 44 years old， averaged （27.6±3.7） years. Gestational week of 27 to 43 weeks. Among them， 1 case was multipara primipara， 7 cases were the parturient woman. All the patients were treated with dexamethasone 20 mg intravenous injection， oxygen mask pressure， opening a plurality of venous channels； atropine 0.5-1.5 mg and aminophylline 250 mg on respiratory， circulatory system significantly relieve symptoms， pulmonary hypertension. Among them 4 cases were treated with the above symptoms disappeared after treatment， no more than the disease remission continue to give dexamethasone 20 mg intravenous injection， and anti shock treatment. Results In 8 cases of AFE， 2 cases of premature rupture of membranes， 3 cases used oxytocin induction of labor， cesarean section in 2 cases， the other 1 case. In 2 patients after successful cardiopulmonary resuscitation without DIC. The amount of vaginal bleeding for