Ray Barry K, Vallejo Manuel C, Creinin Mitchell D, Shannon Kelly T, Mandell Gordon L, Kaul Bupesh, Ramanathan Sivam
Department of Anesthesiology, Magee Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Can J Anaesth. 2004 Feb;51(2):139-44. doi: 10.1007/BF03018773.
Describe the diagnosis, clinical features, pathophysiology, treatment and anesthetic management of amniotic fluid embolism (AFE) in a patient undergoing second trimester pregnancy termination.
A 30-yr-old gravida 2, para 1, woman was admitted for a dilatation and evacuation procedure for underlying intra-uterine fetal demise in her second trimester of pregnancy. Hypotension, shock, respiratory arrest, pulseless electrical activity, hemorrhage, disseminated intravascular coagulopathy, requiring cardiopulmonary resuscitation and blood transfusion complicated her intraoperative care. AFE was considered the most likely cause of this intraoperative event.
It is now recognized that the pathophysiological features of AFE are similar to a type-1 hypersensitivity reaction ranging from mild systemic reaction to anaphylaxis and shock. AFE has a high maternal and fetal morbidity and mortality rate, requiring prompt recognition and treatment. In patients with cardiovascular instability, the treatment of AFE is similar to anaphylaxis requiring aggressive fluid hydration, cardiopulmonary resuscitation, administration of blood products and the use of vasopressors.
描述一名中期妊娠终止患者羊水栓塞（AFE）的诊断、临床特征、病理生理学、治疗及麻醉管理。
一名30岁、孕2产1的女性因妊娠中期胎儿宫内死亡行扩张刮宫术入院。术中出现低血压、休克、呼吸骤停、无脉电活动、出血、弥散性血管内凝血，需要心肺复苏及输血，使术中护理复杂化。AFE被认为是此次术中事件最可能的原因。
现在人们认识到，AFE的病理生理特征类似于从轻度全身反应到过敏反应和休克的1型超敏反应。AFE母婴发病率和死亡率很高，需要及时识别和治疗。对于心血管不稳定的患者，AFE的治疗类似于过敏反应，需要积极补液、心肺复苏、输注血液制品及使用血管升压药。
