羊水栓塞导致孕产妇死亡的病理诊断和预防  

Pathologic Diagnosis and Prevention of Maternal Mortality Due to Amniotic Fluid Embolism

作　　者：杨烨 YANG Ye(Department of Gynecology,Jinzhou Women and Children Hospital,Jinzhou 121000,China)

机构地区：[1]辽宁省锦州市妇婴医院妇科,辽宁锦州121000

出　　处：《中国医药指南》2020年第7期18-19,共2页Guide of China Medicine

摘　　要：目的分析并研究羊水栓塞导致孕妇死亡的相关因素和预防措施。方法选取2008年7月至2018年6月在我市收治的128例羊水栓塞孕妇作为研究对象,对所有孕妇进行回顾性分析,调查羊水栓塞死亡孕妇的发生率,同时对羊水栓塞导致孕妇死亡的病理诊断状况进行评价,总结孕妇出现羊水栓塞的临床症状、发生时间地点、产科等相关因素和评审结果。结果本研究128例羊水栓塞孕妇发生羊水栓塞死亡的10例(占7.81%)。评价所有孕妇分娩地点:市级医院1例,基层医院4例,非正规医疗场所6例;10例孕妇当中,经产妇7例,初产妇3例;所有研究对象均在临产以后出现羊水栓塞;本研究临床诊断8例为羊水栓塞;血液涂片和尸检诊断各1例;对所有研究对象进行分析,不可避免死亡病例为4例,可避免或建立条件可避免死亡病例6例;症状发生到死亡的时间为1 h内病例1例,1~2 h 4例,2~4 h 3例,超过4 h的2例;采用米索前列醇进行干预的3例,人工破膜干预1例,不合理使用缩宫素5例,经产钳助产1例。结论临床强化对于孕产妇早期症状的监测,防止缩宫素滥用,提升基层人员的专业技能和诊断水平,可在一定程度上降低羊水栓塞病死率。Objective To analyze and study the related factors and preventive measures of amniotic fluid embolization in pregnant women. Methods This study respondents were from the city in July 2008 to June 2018 treated by pregnant women, choose the records of 128 cases of amniotic fluid embolism during this time the city pregnant women as the research object, for all pregnant women were analyzed retrospectively, investigate the incidence rate of amniotic fluid embolism death of pregnant women, the pathological diagnosis of amniotic fluid embolism death in pregnant women status evaluation, to summarize the clinical symptoms of the pregnant women in amniotic fluid embolism, related factors such as time and place, obstetric and review results. Results In this study, 10 of 128 pregnant women with amniotic fluid embolization died, accounting for 7.81%. Evaluation of all pregnant women delivery places: 1 case in municipal hospital, 4 cases in grassroots hospital and 6 cases in informal medical places;Among the 10 pregnant women, there were 7 parturients and 3 parturients. All the subjects had amniotic embolism after labor. In this study, 8 cases were clinically diagnosed as amniotic embolism. Blood smear and autopsy diagnosis were 1 case each. All the subjects were analyzed. There were 4 cases of inevitable death, and 6 cases of avoidable death were avoided or conditions were established. The time between symptom onset and death was 1 case within 1 h, 1-2 hours 4 case, 2-4 hours 3 case, and 2 cases over 4 hours. There were 3 cases of misoprostol intervention, 1 case of artificial membrane intervention, 5 cases of unreasonable use of oxytocin, and 1 case of birth by forceps. Conclusion Clinical intensification of monitoring of early symptoms of pregnant and pregnant women, preventing the abuse of oxytocin, and improving the professional skills and diagnostic level of grassroots staff can reduce the mortality rate of amniotic fluid embolism to a certain extent.

关 键 词：羊水栓塞 孕妇死亡 病理诊断 

分 类 号：R714.468[医药卫生—妇产科学]