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1、时间反复无常，鼓着翅膀飞逝,羊水栓塞的早期识别和团队流程化抢救,Internal and Child Health Hospital Affiliated to Anhui Medical Universit医計六子油纷保法羊水栓塞的早期识别和团队流程化抢救安徽医科大学附属妇幼保健院,Internal and Child Health Hospital Affiliated to Anhui Medical Universit医計六子油纷保法201215页新生儿死206亡率(%)孕产妇死亡率(1/10万农村合计城市农村:中卫生和计划生育统计年鉴71.180.046.3100.070121.42
2、0.7国家卫生和计划生育委员会翁340.450.23.161.9639.643.222.358.22003833.451.327.665.4028.548.326.163.0200612.0623.641.124.845.52007021.836.625.241.32008922.734.229.236.10.130.029.730.119.126.125.226.5014.523.222.423.62014中他和熏科学虫私914.2,Internal and Child Health Hospital Affiliated to Anhui Medical Universit医計六子油纷保法
3、要疾病死亡率(1/10万死亡总数2肝病201083373.32.80.40.927812310.99.21.237.2,910.40.60.827.010.9126.62.60.628.21147.813.30.65.72.02.53.20.21.026.39111414.91.14.64.22.33.31.90.I1.021.11L616.49.50.74.7城市192.82.5030.927.18.39.48.31.031502.02.0304.319.72.97.914.50.05.3201257151.539030.825670701741.23.520135.6212.12.70.0
4、0.925.0929.211.801.31.42.32.70.20.821.27111.113.11.04.03.50.95.20.70.20.717.94826.23.61.23.633.428.01421.39.41,33.133.2112.110.6.92.81.73.30.20.529.312.17.313.80.92.220146.32.22.60.31.128.310011.6,Internal and Child Health Hospital Affiliated to Anhui Medical Universit医計六子油纷保法发生在手术室426岁初产妇,因妊娠39周,头盆
5、不称,在硬膜外麻醉下行剖宫产术4胎儿取出后,产妇突感寒战,呼吸困难,4BP:100/50mmHg,心率快而弱,肺部听诊有湿罗音,子宫出血不止,Internal and Child Health Hospital Affiliated to Anhui Medical Universit医計六子油纷保法羊水栓塞(Amniotic Fluid Embolism. AFE)4产程中或胎儿娩出后4突然出现的喘憋心肺功能衰竭昏迷意识丧失甚至心跳骤停DC所致严重产后出血为特征的产科并发症4病死率高达20%60%,Internal and Child Health Hospital Affiliated t
6、o Anhui Medical Universit医計六子油纷保法发生率4羊水栓塞的发生率为1800001/8000临床表现的多样性和缺乏客观、统一的诊断标准有些研究存在过度诊断现象基于全国的登记和统一的诊断标准,羊水栓塞的10年发生率日本为5/10万争英国为20/10万美国为8/10万4我国缺乏大规模的羊水栓塞发生率的调查应建立全国性的统规范登记、报告和专家审核制度,Internal and Child Health Hospital Affiliated to Anhui Medical Universit医計六子油纷保法机制肺动脉高压弥散性血管内凝血羊水内有形物质直接形成栓子羊水成分激活
7、外源性凝血系统经肺动脉进入肺循环阻塞小,在血管内产生大量的微血栓血管引起肺动脉高压消耗大量凝血因子及纤维蛋白原,致使Dc发生病理生理过敏性休克急性肾功能衰竭(ARF羊水成分为致敏原,引起型变态反应,立即出现休克由于休克和DC,肾急性缺血导致肾功能障碍和衰竭,Internal and Child Health Hospital Affiliated to Anhui Medical Universit水内大量水内抗原水中有形物(胎促凝血物质脂、粘液、毳毛、胎便、脱落上皮)启动凝血系统型变态反应刺激血栓阻塞进入肺循环肺小血管机械阻塞肺组织产生、反射性兴奋小支气管痉挛支气管分泌物较小的肺释放PGF2
8、a迷走神经血管PE2及5羟色胺等血管活性加重肺通气、换气肺小血管痉挛肺动脉高压急性右心衰呼吸循环功能竭,Internal and Child Health Hospital Affiliated to Anhui Medical Universit医計六子油纷保法羊水中有促凝物质组织凝血活酶,第X因子羊水中还有纤溶酶勋表面活性物质,胎便中有胰蛋白激活纤溶系统血小板聚集、使凝血酶原转化为凝血酶纤溶亢进激活纤维蛋白降解产物血液的外凝系统(微血栓、消耗大量凝血因DIC,Internal and Child Health Hospital Affiliated to Anhui Medical Universit医計六子油纷保法循环功能衰竭DIC肾缺血、缺氧血栓堵塞肾内小血管肾器质性损害急性肾功衰竭,1、最灵繁的人也看不见自己的背脊。非洲2、最困难的事情就是认识自己。希腊3、有勇气承担命运这才是英雄好汉。黑塞4、与肝胆人共事，无字句处读书。周恩来5、阅读使人充实，会谈使人敏捷，写作使人精确。培根,
