中国实用妇科与产科杂志

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羊水栓塞的诊断标准

  

  1. 1.山东省妇幼保健院产科,山东 济南 250014;2.国家卫生健康委生育调控技术重点实验室,山东 济南 250014;3.山东大学附属省立医院产科,山东 济南 250021
  • 出版日期:2019-07-02 发布日期:2019-07-05
  • 通讯作者: 王谢桐
  • 基金资助:

    泰山学者工程专项经费

Diagnostic criteria for amniotic fluid embolism.

  1. Department of Obstetrics and Gynecology,Shandong Maternal and Child Healthcare Hospital,Jinan 250014,China
  • Online:2019-07-02 Published:2019-07-05

摘要:

羊水栓塞是一种罕见的妊娠期严重并发症,是导致孕产妇死亡的重要原因。迄今为止,尚缺乏明确统一的诊断标准,是基于产时及产后30 min内发生的,无法解释的肺动脉高压、低氧血症、低血压及发生在大量出血之前的凝血功能障碍等临床表现的排除性诊断。不推荐任何实验室诊断用于确诊或排除羊水栓塞,但血常规、凝血功能、血气分析、心电图、心肌酶谱、胸片、超声心动图、血栓弹力图、血流动力学监测等有助于羊水栓塞的诊断、病情监测及治疗。及早治疗可以改善预后。因此,对于每一例突然发生肺动脉高压、低氧血症、低血压、凝血功能障碍等临床表现的孕产妇,都应考虑到羊水栓塞的可能。对于临床高度怀疑羊水栓塞者,治疗可以先于明确诊断。

关键词: 羊水栓塞, 诊断, 标准

Abstract:

Amniotic fluid embolism is a rare and serious pregnancy complication and is an important cause of maternal death .Up to now,amniotic fluid embolism still lacks a clear and unified diagnostic standard,and it is only an exclusion diagnosis based on the clinical manifestations such as pulmonary hypertension,hypoxemia,hypotension,and coagulation dysfunction before massive hemorrhage that cannot be explained during labor and within 30 minutes after delivery.It is not recommended that any laboratory diagnosis be used for the diagnosis or exclusion of AFE,but blood routine,coagulation function,blood gas analysis,electrocardiogram,myocardial enzyme spectrum,chest X-ray,echocardiography,thromboelastic diagram,and hemodynamic monitoring are helpful for the diagnosis,condition monitoring and treatment of amniotic fluid embolism.Early treatment can improve the prognosis,so for every case of sudden pulmonary hypertension,hypoxemia,hypotension,coagulation dysfunction and other maternal symptoms,the possibility of amniotic fluid embolism should be considered.For clinically highly suspected amniotic fluid embolism,treatment can be performed before a definite diagnosis.

Key words: amniotic fluid embolism, diagnosis, criterion

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