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[羊水栓塞后复杂但成功的复苏]

[Complicated but successful resuscitation after amniotic fluid embolism].

作者信息

Bouman E A, Gutiérrez y Leon J A, van der Salm P C, Christiaens G C, Bruinse H W, Broeders I A

机构信息

Afd. Anesthesiologie, Universitair Medisch Centrum, Postbus 85.500, 3508 GA Utrecht.

出版信息

Ned Tijdschr Geneeskd. 2001 Apr 14;145(15):747-9.

Abstract

A 33-year-old woman, gravida IV, para III with unexplained polyhydramnios was admitted to give birth at 29 weeks of pregnancy. Directly after the spontaneous breaking of the membranes, asystolia occurred. Following emergency resuscitation the sinus rhythm returned. Upon the relaparotomy due to a large filling requirement and increasing abdomen size, 'crush' lesions to the spleen and liver were visible; following this a splenectomy was carried out and tampons applied to the liver. After seven months the patient had slight residual symptoms; three weeks after his birth her son was transferred in good condition to another hospital. Amniotic fluid embolism is a rare complication of pregnancy with often serious complications for mother and child. The diagnosis is based on the clinical symptoms of cardiac arrest or sudden profound shock, acute respiratory failure, and/or disseminated intravascular coagulation, occurring in most cases during or soon after delivery, in the absence of an alternative cause (in particular primary cardiopulmonary causes). If the clinical picture deviates from the expected post-resuscitation course alternative diagnoses or resuscitation injuries must be considered.

摘要

一名33岁、孕4产3的妇女因不明原因羊水过多于妊娠29周入院待产。胎膜自然破裂后立即出现心搏停止。紧急复苏后窦性心律恢复。因大量补液需求及腹部增大行再次剖腹探查时,可见脾脏和肝脏有“挤压”损伤;随后行脾切除术,并对肝脏应用填塞物。7个月后患者有轻微残留症状;其儿子出生3周后情况良好地转至另一家医院。羊水栓塞是妊娠的一种罕见并发症,对母婴常造成严重并发症。诊断基于心脏骤停或突然严重休克、急性呼吸衰竭和/或弥散性血管内凝血的临床症状,多数病例发生在分娩期间或分娩后不久,且无其他原因(特别是原发性心肺原因)。如果临床表现与复苏后的预期病程不符,则必须考虑其他诊断或复苏损伤。

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