分娩中羊水栓塞的成功处置：一例临床危重病例报告及文献复习

吴思雨，于芳，侯海燕，邢静，陈亚琼

分娩中羊水栓塞的成功处置：一例临床危重病例报告及文献复习

吴思雨#，于芳#，侯海燕，邢静，陈亚琼

羊水栓塞（amniotic fluid embolism，AFE）是一种进展迅猛的严重分娩并发症，其发病率为2/100 000～6/100 000，产妇病死率为61%～86%，新生儿存活率为70%。报告1例极重症羊水栓塞病例情况，并对既往文献进行复习综述。该病例为33岁经产妇，患有妊娠期贫血，在分娩过程中发生AFE。首发症状为急性呼吸衰竭，在此情况下行产钳助产。初诊为AFE，转入手术室抢救。患者失血过多并出现凝血功能障碍，因大出血（约3 000 mL）行子宫次全切除术，而后持续输入血制品。患者术后转至重症监护病房（ICU）继续治疗，因慢性肾功能衰竭接受持续性床旁血液滤过，而后间断行血液净化治疗。治疗3个月后病情好转出院，新生儿存活，未遗留神经系统异常。患者现为慢性肾功能不全，定期门诊透析治疗。

栓塞，羊水；剖宫产术；心肺复苏术；肾功能衰竭

【Abstract】Amniotic fluid embolism （AFE）is widely known as a disastrous rapid-progressing intrapartum complication. The incident ranges from 2/100 000 to 6/100 000.The mortality rate reaches 61%—86%.Neonatal survival is reported at 70%. We describe a case of severe AFE in our practice and review the relevant documents.A 33-year pluripara developed amniotic fluid embolism during labour.The mother identified as gestational anemia when came to our hospital with acute respiratory failure to be her initial symptom.A forceps delivery was performed.She showed extreme blood loss complicated by disseminated coagulopathy.A subtotal hysterectomy was performed due to approximately 3000 mL bleeding.Aggressive management was practiced with continuous transfusion of blood products.Haemodialysis was performed because of chronic renal failure after her being transmitted to ICU.The patient had been treated for 3 months and discharged from hospital with an improved condition and a survived baby without neurological damage.The patient receives dialysis regularly due to chronic renal failure.

【Keywords】Embolism，amniotic fluid；Caesarean section；Cardiopulmonary resuscitation；Renal failure

（J Int Obstet Gynecol，2015，42：384-386）

羊水栓塞（amniotic fluid embolism，AFE）是一种不可预知且危及生命的罕见分娩期并发症。1926年，Meyer第一次描述了这种疾病。Steiner和Luschbaugh检查了8例分娩中突然死亡的病例，于1941年将其确立为一类临床疾病。AFE的发病率为2/100 000～6/100 000［1-4］，产妇病死率为61%～86%［5-6］。据评估，AFE在产妇死因中占10%［5-6］。临床表现涵盖了一系列症状，包括器官亚临床病理损害、心肺功能障碍、凝血功能障碍甚至死亡［5-6］。因为涉及多种体液和免疫因子，Clark等［6］建议将AFE更名为妊娠过敏反应综合征。Benson［7］认为，羊水中的胎儿物质进入母体循环系统，引起的免疫反应参与了AFE的病理生理过程。……