羊水栓塞38例临床分析  

The Clinical Analysis of 38 Cases with Amniotic Fluid Embolism

作　　者：杨伟文[1] 周宁渝 周永兰 李蓉 

机构地区：[1]苏州医学院附属第一医院妇产科,215006 [2]苏州市妇儿保健所

出　　处：《中华妇产科杂志》2000年第2期75-78,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的　通过对 38例羊水栓塞患者的临床分析 ,找出其诱发高危因素 ,并提出防治措施。方法　对苏州市及所属 6个县、市 1984～ 1998年中发生的 38例羊水栓塞患者的临床资料进行回顾性分析 ,按每 3年为 1个阶段划分为 5个阶段。结果　在 1984～ 1998年的 15年中 ,共发生羊水栓塞 38例 ,其中初产妇 30例 (含双胎 1例 ) ,经产妇 8例。开始的前 4个阶段 ,31例全部死亡 ,第 5阶段 ,7例中有 3例死亡 ,4例存活。羊水栓塞死亡率占同期孕产妇死亡的 15 0 % ,为孕产妇死亡的第 2位原因。急性羊水栓塞 32例 ,迟发型 6例。孕 2 8周前发生 2例 (5 2 % ) ,孕晚期 36例 ,其中 2 0例 (5 2 6 % )发生在产程中 ,13例 (34 2 % )发生在分娩后 ,3例未进入产程即发病。全部病例均有呼吸困难、青紫、胸闷、休克和心肺循环障碍 ,12例血液中找到羊水物质 ,1例尸解确诊 ;16例产后出血和 (或 )实验室DIC指标阳性。 38例患者中发病后 1h内死亡 15例 (39 5 % )。其主要诱因为使用缩宫剂或因宫缩强自然破膜者占 17例 (44 7% ) ,合并妊娠高血压综合征者 11例 (2 8 9% ) ,高龄经产妇 9例 (2 3 7% ) ,剖宫产术 8例 (2 1 1% )。结论　对突然出现原因不明呼吸困难、青紫及胸闷等的心肺功能障碍的孕产妇 ,特别是有一过性过敏反应者 ,应警?Objective To analyze the clinical course of amniotic fluid embolism (AFE) and identify the high risk factors. Methods Thirty eight cases diagnosed as AFE in Suzhou region during period of past 15 years were analyzed retrospectively. Fifteen years were divided into 5 stages with 3 years each. Results Of 38 cases, 30 (78.9%) were primigravida and one twins. There were 34 maternal deaths. Among them, 31 died in the first four stages and 3 died in the last stage. There were 4 cases survived from AFE in the last stage. AFE accounted for 15% of tatol maternal deaths in the past 15 years, which is the second cause of maternal death. Of 38 cases, 2 (5.2%) occurred before 28 gestational weeks. 20(52.6%) suffered from AFE during labour, 13(34.2%) after delivery, and 3 (7.8%) before labour. All cases presented respiratory distress, cyanosis, chest discomfort and/or shock, cardiopulmonary collapse. Sixteen cases had postpartum hemorrhage and/or laboratory evidence of DIC. Of 38 cases, 15 (39.5%) died within one hour after onset of AFE. The predisposing factors for AFE included strong uterine contractions due to oxytocin or PEG augmented 17 cases (44.7%), pregnancy induced hypertension 11 cases (28.9%), multigravida and/or elder gravida 9 cases (23.7%) and cesarean section 8 cases (21.1%). Conclusions AFE must be suspected in maternal cases with sudden collapse, especially the clinical symptoms of allergic reaction. Prevention of hypertonic uterine contraction and prompt resuscitation, and emergency surgical delivery can improve the prognosis of AFE.

关 键 词：羊水栓塞 死亡率 危险因素 

分 类 号：R714.4[医药卫生—妇产科学]