羊水栓塞临床分析--附78例报告

目的探讨羊水栓塞(amniotic fluid embolism,AFE)的诊断和处理原则.方法对我院1999年建院以来诊治的1例AFE临床资料及1994年以来国内文献报道的AFE 77例进行综合分析.结果78例AFE中,71.8%是经产妇,其发病诱因依次为使用催产素或米索等、胎膜早破、剖宫产术、宫缩过强或急产、人工破膜、羊膜腔穿刺引产及钳刮术.主要临床表现为休克(66.7%)、DIC(56.4%)、胸闷(51.3%)、发绀(48.7%)、呼吸困难(46.2%)、昏迷(39.7%).孕产妇死亡20例(20/78,25.6%);存活58例中,子宫切除13例(13/58,22.4%).死亡组中,7例及早诊断,1例使用肝素;存活组中,55例及早诊断,20例使用肝素.两者均有显著差异(P＜0.01).发生羊水栓塞后,其围产儿死亡率为72.7%.结论AFE抢救成功的关键是根据临床表现及早诊断,尽早使用肝素,适时行子宫切除术.

Clinical analysis of amniotic fluid embolism: seventy-eight cases report

Objective To investigate the diagnosis and treatment of amniotic fluid embolism (AFE). Methods The clinical data of one patient with AFE in our hospital, and the chinese literatures of 77 cases of AFE during the past 10 years were analyzed retrospectively. Results Of 78 patients with AFE, fifty-one (71.8%) were multipara. The predisposing factors included the use of oxytocic or miso, premature rupture of membranes, caesarean section,uterine hypercontractility or precipitate delivery, artificial rupture of membranes, induction of labour by amniocentesis and curettage. The main clinical symptoms presented shock(66.7%), DIC(56.4%), chest distress(51.3%), cyanosis(48.7%),dyspnea(46.2%) and coma (39.7%). The maternal mortality rate was 25.6%, and the perinatal mortality rate was 72. 7%. Thirteen patients underwent the excision of uterus. Of 20 dead cases, 7 were confirmed immediately, and 1 was treated with heparin.Of 58 living cases,55 were confirmed immediately, and 20 were treated with heparin. Both of two groups had statistically difference(P < 0. 01). Conclusion Making diagnosis and using of heparin as early as possible, and proper excision of uterus, are the key to cure AFE.