三级妇产专科医院羊水栓塞13例诊治及文献复习

 目的 总结羊水栓塞患者的临床资料,探讨羊水栓塞的发生机制,分享羊水栓塞救治经验。方法 回顾性分析2011-03至2018-11在北京妇产医院孕晚期分娩并发羊水栓塞患者的症状、体征、实验室等辅助检查、用药救治过程,以及母儿妊娠结局与预后。结果 在109 401次孕晚期分娩记录中,共发生13例羊水栓塞,发病率11.88/10万。高龄(超过35岁)产妇占比53.8%(7/13),经产妇占比53.8%(7/13),存在过敏性体质患者4例,胎盘高危因素4例,妊娠期高血压疾病患者3例。84.6%(11/13)的患者出现了危及生命体征的临床表现(至少低血压、低血氧、DIC之一),3例出现心脏呼吸骤停,5例并发DIC,产后出血(>1000 ml以上)者9例[1100~6000 ml,(2963±406)ml]。4例血液中查找羊水成分,其中3例阳性,9例使用大量血管活性药物时间超过3 h,5例行子宫切除术,无患者死亡。结论 羊水栓塞主要依靠临床表现进行诊断;典型的羊水栓塞是产科罕见而凶险的并发症;及时准确的诊断以及训练有素的多学科快速反应团队,及时足量的抗过敏和血管活性药物以及后续充分的生命支持治疗是挽救羊水栓塞患者生命的关键措施。

13 cases analysis of amniotic fluid embolism in diagnosis and treatment in tertiary obstetric and gynecology hospital

Objective To summarize the clinical data of amniotic fluid embolism and to explore the mechanism of amniotic fluid embolism.Methods From March 2011 to November 2018, the symptoms, signs, laboratory examinations, medication treatment, maternal and fetal pregnancy outcomes and prognosis of patients with amniotic fluid embolism during late pregnancy in Beijing Obstetrics and Gynecology Hospital were retrospectively recorded.Results Among the 109401 late pregnancy delivery records in our hospital, there were 13 cases of amniotic fluid embolism, with an incidence of 11.88/100 000, 53.8% (7/13) of pregnant women over 35 years old, 53.8% (7/13) of multipartum, 4 cases of allergic history, 4 cases of high placental risk factors, and 3 cases of pregnancy-induced hypertension. 84.6% (11/13) of the patients had at least one of clinical life-threatening signs (and/or hypotension, hypoxia, DIC), 3 patients had cardiac arrest, 5 patients had DIC, and 9 patients had postpartum hemorrhage (more than 1000 ml) [1100-6000 ml, (2963±406) ml]. Among the 4 patients, 3 were positive for amniotic fluid components from blood samples, 9 were treated with large amounts of vasoactive mediaters for more than 3 hours, and 5 underwent hysterectomy without death.Conclusions Amniotic fluid embolism mainly depends on clinical manifestations for diagnosis. Typical amniotic fluid embolism is a rare and extremely dangerous delivery complication. Timely and accurate diagnosis and well-trained multidisciplinary rapid response team, instant and adequate antiallergic and vasoactive drugs and accurate life support therapy are the key measures to save the lives of patients with amniotic fluid embolism.