羊水栓塞10例临床分析

目的：分析10例羊水栓塞的诱发因素及临床诊断、处理。方法收集2003年1月至2013年12月间在首都医科大学附属北京妇产医院分娩的孕产妇发生的10例羊水栓塞进行回顾性分析。结果羊水栓塞的发病率0．79／10000，病死率20％。发病时，所有患者胎膜均已破裂，合并重度子痫前期5人，8位患者既往有妊娠史。前驱症状包括呼吸系统（胸闷憋气、呛咳、呼吸困难、血氧饱和度下降），循环系统（晕厥、萎靡、呼吸心跳骤停）和／或出血，每1个患者都出现了持续的产后出血。7例需手术止血，需手术止血的患者均切除子宫。结论羊水栓塞是一种罕见且严重的疾病，高危因素有男性胎儿、胎膜破裂及重度子痫前期等。羊水栓塞的早期诊断主张根据临床症状和体征，一旦诊断立即抢救。抢救同时给予抗过敏，呼吸循环支持及补充血容量，纠正凝血障碍，必要时切除子宫。

Retrospective study of 10 cases of amniotic fluid embolism

Objective To analyze the induced factors, clinical diagnosis and treatment of 10 cases of amniotic fluid embolism (AFE). Methods Retrospective study was carried out among 10 cases of AFE occurred in Beijing Gynecology and Obstetrics Hospital Affiliated to Capital Medical University between January 2003 and December 2013.Results The incidence of AFE was 0.79/10 000, and the case fatality rate was 20%.All of the patients had ruptured membranes before attack .Five patients had severe preeclampsia , and 8 had pregnancy history .Maternal herald signs included respiratory system ( short of breath , bucking , dyspnea , descending of saturation of blood oxygen), cardiovascular system (syncope, malaise, cardiorespiratory arrest) and/or hemorrhage.Every case suffered continuous bleeding . Surgical intervention to achieve hemostasis was necessary in 7 cases, and all of them had hysterectomy ultimately .Conclusion AFE is a rare but extremely serious disease .Risk factors for AFE include male fetus , rupture of membrane , severe preeclampsia , etc.The diagnosis of AFE should be based on clinical manifestations and signs , and the cases should be rescued as soon as they were diagnosed .At the same time, antianaphylaxis treatment , respiratory and circulation support , supplementary of blood volume and correction of coagulation disorders need to be provided .Hysterectomy is performed if necessary .