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羊水栓塞38例临床分析 |
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杨伟文 周宁渝 周永兰 李蓉
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28周前发生2例(5.2%)，孕晚期36例，其中20例(52.6%)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1 h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(28.9%)，高龄经产妇9例(23.7%)，剖宫产术8例(21.1%)。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，应警惕羊水栓塞的可能。避免高张力型宫缩。高龄经产妇及妊娠高血压综合征为高危因素。急诊剖宫产可提高抢救的成功率。
关键词：栓塞，羊水； 死亡率；危险因素
The Clinical Analysis of 38 Cases with Amniotic Fluid Embolism
YANG Weiwen ZHOU Ningyu ZHOU Yonglan et al
（Department of Obstetrics and Gynecology, First Affiliated Hospital to Suzhou Medical College. Suzhou 215006, China）
Abstract：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 [1] [2] 下一页
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