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什么是羊水栓塞

羊水栓塞的原因

羊水栓塞的临床表现

羊水栓塞的鉴别诊断

羊水栓塞的并发症

羊水栓塞的抢救措施

怎样预防羊水栓塞

羊水栓塞

词条摘要

羊水栓塞
近年来,从轰动全国的产妇羊水栓塞死亡事件开始,这个词引起了大家的广泛关注。那么究竟什么是羊水栓塞?羊水栓塞的原因是什么?羊水栓塞的临床表现怎么样的?羊水栓塞如何鉴别诊断?羊水栓塞的并发症有哪些?羊水栓塞如何抢救?怎样预防羊水栓塞?

什么是羊水栓塞

羊水栓塞是指在分娩过程中羊水突然进入母体血液循环引起急性肺栓塞,过敏性休克,弥散性血管内凝血,肾功能衰竭或猝死的严重的分娩期并发症,发病率为4/10万~6/10万。

YANGSHUISHUANSAISHIYOUYUWURANYANGSHUIZHONGDEYOUXINGWUZHI(TAIERCUIMAO,JIAOHUASHANGPI,TAIZHI,TAIFEN)HECUNINGWUZHIJINRUMUTIXUEYEXUNHUANYINQI。

近年研究认为,羊水栓塞主要是过敏反应,是羊水进入母体循环后,引起母体对胎儿抗原产生的一系列过敏反应,故建议命名为“妊娠过敏反应综合征”。

羊水栓塞的原因

YANGSHUISHUANSAIDUOFASHENGZAICHANSHIHUOPOMOSHI,YIKEFASHENGYUCHANHOU,DUOJIANYUZUYUECHAN,DANYEJIANYUZHONGQIYINCHANHUOQIANGUASHUZHONG,DADUOFABINGTURAN,BINGQINGXIONGXIAN。

YANGSHUISHUANSAIDEFASHENGTONGCHANGXUYAOJUBEIYIXIAJIBENTIAOJIAN:

1、羊膜腔内压力增高(子宫收缩过强或强直性子宫收缩);
  2、胎膜破裂(其中2/3为胎膜早破,1/3为胎膜自破);
  3、宫颈或宫体损伤处有开放的静脉或血窦。
  发生羊水栓塞通常有以下诱因:
  1、经产妇居多;
  2、多有胎膜早破或人工破膜史;
  3、常见于宫缩过强或缩宫素(催产素)应用不当;
  4、胎盘早期剥离、前置胎盘、子宫破裂或手术产易发生羊水栓塞。

羊水栓塞的临床表现

YANGSHUISHUANSAIDEFABINGTEDIANSHIQIBINGJIZHOU、LAISHIXIONGXIAN,DUOFASHENGZAIFENMIANGUOCHENGZHONG,YOUQISHITAIERMIANCHUQIANHOUDEDUANSHIJIANNEI。YANGSHUISHUANSAIFASHENGSHI,CHANFUZAIJIDUANSHIJIANNEIKEYINXINFEISHUAIJIE、XIUKEERSIWANG。RUYANGSHUIQINRULIANGJISHAO,ZEZHENGZHUANGJIAOQING,YOUSHIKEZIXINGHUIFU,RUYANGSHUIHUNZHUOHUORULIANGJIAODUOSHIXIANGJICHUXIANDIANXINGDELINCHUANGBIAOXIAN。YANGSHUISHUANSAIDIANXINGDELINCHUANGBIAOXIANKEFENWEISANGEJIANJINJIEDUAN:

1、XINFEIGONGNENGSHUAIJIEHEXIUKEQI

ZAIFENMIANGUOCHENGZHONG,YOUQISHIGANGGANGPOMOBUJIU,CHANFUTURANFASHENGHANZHAN、QIANGKE、QIJI、FANZAOBUANDENGZHENGZHUANG,SUIHOUCHUXIANFAGAN、HUXIKUNNAN、XINLVJIAKUAI、CHOUCHU、HUNMI、XUEYAXIAJIANGDENGZHENGZHUANG,BINGJINRUXUNHUANSHUAIJIEHEXIUKEZHUANGTAI。FEIBUTINGZHENKEWENJISHILUOYIN,RUOYOUFEISHUIZHONG,HUANZHEKEGEXUEXINGPAOMOZHUANGTAN。YOUDECHANFUTURANJINGJIAOYISHENGHUODAYICIHAQIANHOUXUEYAXUNJIXIAJIANGSHENZHIXIAOSHI,BINGZAIJIFENZHONGNEISIWANG。

2、DICYINQIDECHUXUEQI

CHANFUDUGUOLEXINFEIGONGNENGSHUAIJIEHEXIUKEJIEDUAN,ZEJINRUNINGXUEGONGNENGZHANGAIJIEDUAN,BIAOXIANWEIDALIANGYINDAOLIUXUE、XUEYEBUNINGGU,QIEKOUJIZHENYANDALIANGSHENXUE,QUANSHENPIFUZHANMOCHUXUE,YOUSHIKEYOUXIAOHUADAOHUOMINIAODAODALIANGCHUXUE,CHUXIANOUXUE、BIANXUEJIXUENIAODENG。

3、急性肾功能衰竭

YOUYUQUANSHENXUNHUANSHUAIJIE,SHENZANGXUELIULIANGJIANSHAO,CHUXIANSHENZANGWEIXUEGUANSHUANSAI,SHENZANGQUEXUEYINQISHENZUZHISUNHAI,BIAOXIANWEINIAOSHAO、WUNIAOHENIAODUZHENGZHENGXIANG。YIDANSHENZANGSHOUSUN,KEZHISHENGONGNENGSHUAIJIE。

羊水栓塞临床表现的三个阶段基本上按顺序出现,但有时亦可不全出现或出现的症状不典型。

羊水栓塞的鉴别诊断

YANGSHUISHUANSAIRONGYIWUZHENWEIQITADEJIBING:

1.ZIXIANCHOUCHU

TONGCHANGYOUGAOXUEYA、SHUIZHONGJIDANBAINIAOSHI,ZAICHANQIAN、CHANSHI、CHANHOUJUNKEFASHENG,WUTAIMOPOLIEYINSU,SHUANGFEITINGZHENYIBANWULUOYIN。DICDEJIANCHAYIBANWUYICHANG。

2.CHONGXUEXINGXINLISHUAIJIE

YOUXINZANGBINGSHI,YOUXINZANGFUDANJIAZHONGDEYOUYIN,HUANZHETUFAXINHUANGQIDUAN,KEPAOMOZHUANGTAN,YIBANWUCHOUCHU、CHUXUEHESHENSHUAIBIAOXIAN。ZAIXINSHUAIKONGZHIHOUZHENGZHUANGNENGHAOZHUAN。

3.NAOXUEGUANYIWAI

HUANZHEYOUGAOXUEYABINGSHI,YOUTOUTONG、TOUYUN,TURANHUNMI,KEFASHENGPIANTAN。

4.DIANXIAN

HUANZHEWANGWANGYOUCHOUFENGBINGSHI,YOUJINGSHENYINSUDEYOUYIN。HUANZHEYIBANWUDICHESHENSHUAI。

5.其他非DIC原因引起的产后出血

YIBANKEZHAODAOMINGQUEDEBINGYIN,WUNINGXUEJIZHIDEGAIBIAN。

6.XUESHUANSHUANSAIXINGJIBING

患者往往有高凝状态、下肢深静脉血栓的表现,一般无出血。

羊水栓塞的并发症

该疾病全身脏器均受损害,除心脏外肾脏是最常受损害的器官。由于肾脏缺氧,出现尿少、尿闭、血尿、氮质血症,可因肾功能衰竭而死亡;脑缺氧时病人可发生烦躁、抽搐、昏迷。 

羊水栓塞的抢救措施

YANGSHUISHUANSAIYIDANQUEZHEN,YINGLIJIQIANGJIUCHANFU。QIZHUYAOYUANZEWEI:GAISHANDIYANGXUEZHENG、KANGGUOMINHEKANGXIUKE、FANGZHIDICHESHENSHUAIJIE、YIJIYUFANGGANRAN。

1、GAISHANDIYANGXUEZHENG

(1)JIYANG,BAOCHIHUXIDAOCHANGTONG。CHUXIANHUXIKUNNAN、FAGANZHE,LIJIMIANZHAOJIYANG。ZHUANRENHULI,BAOCHIHUXIDAODETONGCHANG,ZAIQIANGJIUGUOCHENGZHONGZHENGQUEYOUXIAOJISHIWANCHENGZHILIAOJIHUA。

(2)JIECHUFEIDONGMAIGAOYAJIZHIQIGUANJINGLUAN。XUANYONGYAOWUHUANJIEFEIDONGMAIGAOYAHEGAISHANFEIXUELIUGUANZHU,SHIYUFANGYOUXINSHUAIJIE、HUXISHUAIJIEJIMOSHAOXUNHUANSHUAIJIEDEYOUXIAOCUOSHI。

2、KANGGUOMIN

ZAIGAISHANQUEYANGDETONGSHI,YINGXUNSUKANGGUOMIN。RUGUOCHANFUCHUXIANGUOMINXINGXIUKE,ZEYINGGAIYONGDAJILIANGPIZHIJISU,CHANGXUANYONGQINGHUAKEDESONGJINGMAIDIZHU。

3、KANGXIUKE

(1)KUORONG:JIWEIBUCHONGXUERONGLIANG,ZAIQIANGJIUGUOCHENGZHONG,YINGJINKUAISHUXINXIANXUEYIBUCHONGXUERONGLIANG。

(2)SHENGYA:DINGSHICELIANGXUEYA、MAIBO、HUXI,ZHUNQUEDICEDINGCHUXUELIANG,BINGGUANCHAXUENINGQINGKUANG,TEBIEHULIYINGXIANGXIJILUQINGKUANGHE24hDECHURULIANG。

(3)JIUZHENGSUANZHONGDUHEXINSHUAI:ZAIQIANGJIUGUOCHENGJIANKONGZHEIXIEQINGKUANG,YIDANCHUXIANSUANZHONGDUHUOXINSHUAI,YINGLIJIYONGYAO。FANGZHIXINLISHUAIJIE,DUITIGAOQIANGJIUCHENGGONGLVJUYOUZHONGYAOYIYI。

3、FANGZHIDIC

YANGSHUISHUANSAIZHENDUANYIDANQUELI,JIUYINGKAISHIKANGNINGZHILIAO,JINZAOSHIYONGGANSU,YIYIZHIXUEGUANNEININGXUE,BAOHUSHENZANGGONGNENG。YANGSHUISHUANSAIKEFASHENGZAICHANQIAN、CHANSHIHUOCHANHOU。YINGJINGTIYANZHONGDECHANHOUCHUXUEFASHENG,ZUIANQUANDECUOSHISHIZAIJIGANSUDEJICHUSHANGSHUXINXIANXUE,BINGBUCHONGXIANWEIDANBAIYUAN、XUEXIAOBANXUANYEJIXIANDONGGANXUEJIANGDENG,YIBUCHONGNINGXUEYINZI,ZHIZHICHANHOUCHUXUEBUNING。

4、FANGZHIJIXINGSHENGONGNENGSHUAIJIE

YANGSHUISHUANSAISHISHOULEIQIGUANCHUFEIYUXINZANGWAI,QICIBIANSHIJIANSHENZANG,YINGLIUZHIDAONIAOGUAN,BAOCHIDAONIAOGUANDETONGCHANG,GUANCHANIAODEPAICHULIANGHEXINGZHI,JISHIFANYINGQINGKUANG,CAIQUCUOSHI,FANGZHISHENGONGNENGSHUAIJIE。

5、YUFANGGANRAN

FANGGANRAN,ZAIGEXIANGCAOZUOZHONGYANGEZHIXINGWUYINCAOZUO,ZHENGQUESHIYONGDUISHENZANGDUXINGZUIXIAODEGUANGPUKANGSHENGSU,FANGZHIFEIBUHESHENGZHIDAOGANRAN。

6、CHANKECHULI

(1)FENMIANQIANFASHENGYANGSHUISHUANSAI:YANGSHUISHUANSAIZAITAIERMIANCHUQIANHUOGANGLINCHANERFASHENGSHI,ZAIGAISHANMUTIHUXIXUNHUANGONGNENG,BINGJIUZHENGNINGXUEGONGNENGZHANGAIHOU,JINKUAIJIESHUFENMIAN。

(2)第一产程发病:此时胎儿不能及时娩出,应立即做好剖腹产手术前的准备,行剖腹产结束分娩。

(3)DIERCHANCHENGFABING:GONGKOUYIKAIQUANHUOJIEJINKAIQUANSHIFABINGYINGJISHIZUOHAOYINDAOFENMIANJISHOUSHUZHUCHAN,ZHUNBEIMIANCHUTAIER。JUTIQINGKUANGJUTIFENXI,DUOSHUKEJINGYINDAOFENMIAN。

(4)对子宫的处理:产后对无法控制的阴道流血患者,予以子宫切除术,做好腹部全子宫切除手术的前后准备和护理。切除子宫可减少胎盘剥离面大血窦的出血,控制病情不再继续恶化。

怎样预防羊水栓塞

1、CHANJIANFAXIANKEDAOZHIBINGFAYINSU

通过B超检查可诊断出90%的前置胎盘,使用分娩监视装置可早期发现胎盘早剥。而这2种异常情况可能是造成羊水栓塞的原因。

2、JIAQIANGCHANQIANJIAOYU,ZHUYIYOUFAYINSU

30SUIYISHANGDECHANFU、ZAOCHANHUOGUOQICHANZHEJIJINGCHANFU,YOUQISHITAIMOZAOPO、ZIGONGTIHUOZIGONGJINGFAYUBULIANGDECHANFURONGYIFASHENGYANGSHUISHUANSAI。

DUIYOUYOUFAYINSUZHE,YINGYANMIGUANCHA,TIGAOFASHENGYANGSHUISHUANSAIJINGTI,RUPOUGONGCHAN、QIANZHITAIPAN、TAIPANZAOQIBOLI,JICHANDENG。

3、JISHIGAOZHIYISHENGGANJUE

ZAIFENMIANDEGUOCHENGZHONG,RUGUOCHUXIANXIONGMEN、FANZAO、HANZHANDENGBUSHUFUDEGANJUE,YAOJISHIGAOSUYISHENG,YIBIANYISHENGJIZAOQUANLIZUOCHULI。

4、JISHIXUANZEPOUFUCHAN

RUGUOZAIDIYICHANCHENGFASHENGYANGSHUISHUANSAI,YOUYUTAIBAOBAOBUNENGLIJIMIANCHU,SUIRANBINGQINGJINGQIANGJIUHOUYOUHAOZHUAN,DANYINBINGYINWEIQUCHU,RENGYOUEHUADEKENENG。BIYAOSHIPEIHEYISHENGZUOPOUGONGCHANSHOUSHU、JINKUAIJIESHUFENMIAN,BIMIANZIGONGPOLIEDEWEIQINGFASHENG。

5、BIMIANCHANSHANG、ZIGONGPOLIE、ZIGONGJINGLIESHANGDENG

(1)FENMIANSHIWUSHIGONGSUOGUOQIANG

ZIGONGSHOUSUOGUOQIANGSHIGONGQIANGNEIYALIZENGGAO,KENENGYINQIZIGONGXIADUANNEIMOPOLIE,ZEGONGSUOSHIYANGSHUIYOUJIANXIJINRUMUTI。XUSHIDANGJIYUZHENJINGJIJIYIZHIZIGONGSHOUSUOJI,YIHUANJIANGONGSUO。

(2)YANGEZHANGWOCUICHANSUYINGYONGDEZHIZHENG

HELISHIYONGCUICHANSU,BINGJINXINGBIXUDEGUANCHA。ZAICHANCHENGZHONG,RUGUOZIGONGSHOUSUOGUOYUQIANGLIE,CHANFUYINGGAIPEIHEYISHENGSHIYONGZHENJINGYAOWU,JIANRUOZIGONGDESHOUSUO,YIFANGFASHENGZIGONGPOLIE。

(3)YANGEZHANGWOPOUGONGCHANZHIZHENG

POSHUISHIYINGYONGSHADIANBAOHUHAOQIEKOUBIANYUAN,CIPOYANGMOQIANBAOHUHAOZIGONGQIEKOUSHANGDEKAIFANGXINGXUEGUAN。

(4)YANGEZHANGWORENGONGPOMOZHIZHENG。

RENGONGPOMOSHIBUJIANXINGBOMO,YIJIANSHAOZIGONGJINGGUANDEXIAOXUEGUANPOSUN,BUZAIGONGSUOSHIPOMO。

(5)ZHONGQIYINCHANQIANJIASHUSHI,XIANPOMODAIYANGSHUILIUJING,ZAIQIANJIAYUSHIYONGCUICHANSU。

6、作好第四产程的观察,及时发现与出血不相符合的休克。

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