羊水栓塞9例临床分析  

Clinical analysis of 9 cases of amniotic fluid embolism

作　　者：申屠敏[1] 周锋[1] 潘琢如[1] 

机构地区：[1]上海第二医科大学附属新华医院,200092

出　　处：《中国实用妇科与产科杂志》2005年第2期91-93,共3页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的　分析 9例羊水栓塞的临床处理 ,总结认识与体会。方法　对上海第二医科大学附属新华医院1 96 1～ 1 983年 4例及 1 984～ 2 0 0 0年 5例羊水栓塞的处理、母儿预后临床资料进行回顾性分析。结果　存活 8例 ,死亡 1例 ,1 983年前产妇存活 3例 ,死亡 1例 ,应用肝素 2例 ,总量 1 2 5～ 1 5 0mg。 3例发生前驱症状时 ,1例应用地塞米松 2 0mg静推 ,加作全子宫切除存活 ,2例未用地塞米松其中 1例死亡 ;1 983年后 5例产妇全部存活 ,应用肝素 5例 ,肝素总量仅 2 5～ 75mg。 3例发生前驱症状 ,其中 2例立即给予地塞米松 2 0mg ,未作全子宫切除 ,1例在出血期应用地塞米松 1 0mg ,又行全子宫切除。结论　抢救成功的关键为识别早期症状。较大剂量肾上腺皮质激素可阻断发病环节。肝素的选择性应用 ,剂量宜小不宜大。快速补充血容量及凝血因子 ,充分供氧 ,如需切除子宫应行全子宫切除。Objective To renew approaches in clinical management of AFE.Methods Retrospectively review the management and prognosis of 9 cases of AFE diagnosed in Xin Hua Hospital from 1961 to 1983 and 1984 to 2000. Results Before 1983,3 case survived,1 cases died. 2 cases received heparin with the dose of 125～150mg.During the period of precursory signs in 3 cases, 1 case received intravenous 20mg DX in addition to total hysterectomy.1 case died without DX treatment. After 1983,all of the 5 cases survived,with 25～75mg heparin. 3 cases had precursory signs,and 2 of them were given DX 20mg immediately and hysterectomy was not done. 1 was given DX 10mg during bleeding and total hysterectomy was performed. Conclusion The critical treament of AFE consists of : identification of the precursory signs, interrupting pathophysiology of AFE with larger dose of corticosteroid hormones,small dose of heparin,replacement of volume together with blood products and coagulation components as well as respiratory support and total hysterectomy if necessary.

关 键 词：全子宫切除 地塞米松 肝素 羊水栓塞 存活 前驱症状 死亡 产妇 较大剂量 抢救成功 

分 类 号：R714[医药卫生—妇产科学] R713.42[医药卫生—临床医学]