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中华产科急救电子杂志 ›› 2015, Vol. 04 ›› Issue (02) : 71 -76. doi: 10.3877/cma.j.issn.2095-3259.2015.02.003

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对羊水栓塞的再认识
连岩1, 王谢桐1,()   
  1. 1. 250021 济南,山东省立医院妇产科 山东省妇产医院
  • 收稿日期:2015-01-20 出版日期:2015-05-18
  • 通信作者: 王谢桐

Recognization of amniotic fluid embolism

Yan Lian1, Xietong Wang1()   

  • Received:2015-01-20 Published:2015-05-18
  • Corresponding author: Xietong Wang
引用本文:

连岩, 王谢桐. 对羊水栓塞的再认识[J]. 中华产科急救电子杂志, 2015, 04(02): 71-76.

Yan Lian, Xietong Wang. Recognization of amniotic fluid embolism[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2015, 04(02): 71-76.

羊水栓塞是严重而罕见的产科并发症,其发病机制至今尚未阐明。一直以来,诊断羊水栓塞的金标准是在母体中心静脉血或肺动脉血管床组织切片中找到胎儿的有形成分,但目前的研究已使羊水栓塞的诊断受到质疑,母血中找到胎儿有形成分不再是诊断的必须依据。对于羊水栓塞的诊断,国内强调的是发病机制和病理过程,国外强调的是临床表现。目前认为羊水栓塞的发生无法通过对高危因素的识别和干预进行预测和预防。发生羊水栓塞后的抢救重点主要是支持和对症治疗。

Amniotic fluid embolism (AFE) is a rare but severe complication of pregnancy, and the pathogenesis of amniotic fluid embolism is still poorly understood. The diagnostic criteria of AFE is that fetal tissue was found in the mother′s central vein or pulmonary artery. However, as advances in research, the diagnosis of AFE has been changed. In China, the pathogenesis and pathological process of AFE is emphasized. In the other counties, the clinical manifestation of AFE is emphasized. At present, it is believed that no predicted or preventive measures are possible for AFE through identifying the risk factors. The key point of treating AFE is primarily the supportive and symptomatic treatment.

表1 羊水栓塞发生率及死亡率[4]
表2 羊水栓塞高危因素
表3 "美国羊水栓塞登记"和"英国产科监控系统"的羊水栓塞诊断标准
[1]
Steiner PE, Luschbaugh CC. Landmark article, Oct. 1941: Maternal pulmonary embolism byamniotic fluid as a cause of obstetric shock and unexpected deaths in obstetrics. By Paul E. Steiner and C. C. Lushbaugh[J]. JAMA, 1986, 255(16):2187-2203.
[2]
Clark SL, Hankins GD, Dudley DA, et al. Amniotic fluid embolism: analysis of the national registry[J]. Am J Obstet Gynecol, 1995, 172(4 Pt 1):1158-1167.
[3]
Clark SL. Amniotic fluid embolism[J]. Obstet Gynecol, 2014, 123 (2 Pt 1):337-348.
[4]
Rath WH, Hoferr S, Sinicina I. Amniotic fluid embolism: an interdisciplinary challenge: epidemiology, diagnosis and treatment[J]. Dtsch Arztebl Int, 2014, 111(8):126-132.
[5]
Busardo FP, Frati P, Karch SB, et al. Epidemiological and clinical data of amniotic fluid embolism in forensic settings[J]. Curr Pharm Biotechnol, 2014, 14(14):1189-1194.
[6]
周远洋,朱军,王艳萍,等. 1996-2010年全国孕产妇死亡率变化趋势[J]. 中华预防医学杂志,2011, 45(10):934-939.
[7]
Stolk KH, Zwart JJ, Schutte J, et al. Severe maternal morbidity and mortality from amniotic fluid embolism in the Netherlands[J]. Acta Obstet Gyncol Scand, 2012, 91(8):991-995.
[8]
Roberts CL, Algert CS, Knight M, et al. Amniotic fluid embolism in an Australian population-based cohort[J]. BJOG, 2010, 117(11):1417-1421.
[9]
Stolte L, van Kessel H, Seelen J, et al. Failure to produce the syndrome of amniotic fluid embolism by infusion of amniotic fluid and meconium into monkeys[J]. Am J Obstet Gynecol, 1967, 98(5):694-697.
[10]
Clark SL, Pavlova Z, Horenstein J, et al. Squamous cells in the maternal pulmonary circulation[J]. Am J Obstet Gynecol, 1986, 154(1):104-106.
[11]
Benson MD, Lindberg RE. Amniotic fluid embolism, anaphylaxis, and tryptase[J]. Am J Obstet Gynecol, 1996, 175 (3 Pt 1):737.
[12]
Marcu BJ, Collins KA, Harley RA. Ancillary studies in amniotic fluid embolism: a case report and review of the literature[J]. Am J Forensic Med Pathol, 2005, 26(1): 92-95.
[13]
Benson MD. Current concepts of immunology and diagnosis in amniotic fluid embolism[J]. Clin Dev Immunol, 2012, 2012:946576.
[14]
Benson MD, Kobayashi H, Sehgal RL, et al. Complement, fetal antigen and shaking rigors in parturients[J]. J Matern Fetal Neonatal Med, 2006, 19(1):31-34.
[15]
Benson MD. A hypothesis regarding complement activation and amniotic fluid embolism[J]. Medical Hypotheses, 2007, 68(5):1019-1025.
[16]
Romero R, Kadar N, Vaisbuch E, et al. Maternal death following cardiopulmonary collapse after delivery: amniotic fluid embolism or septic shock due to intrauterine infection?[J]. Am J Reprod Immunol, 2010, 64(2):113-125.
[17]
Uszyński W, ?ekanowska E, Uszyński M, et al. Activation contact system (ACS) and tissue factor (TF) in human amniotic fluid: measurements of ACS components and TF, and some implications on the pathophysiology of amniotic fluid embolism[J]. Thromb Res, 2015, 135(4):699-702.
[18]
池小玲,孙静莉. 羊水栓塞发病机制的免疫学研究进展[J]. 中华临床医师杂志(电子版), 2013, 7(9):4003-4005.
[19]
Rannou B, Rivard GE, Gains MJ, et al. Intravenous injection of autologous amniotic fluid induces transient thrombocytopenia in a gravid rabbit model of amniotic fluid embolism[J]. Vet Clin Pathol, 2011, 40(4):524-529.
[20]
Chen KB, Chang SS, Tseng YL, et al. Amniotic fluid induces platelet-neutrophil aggregation and neutrophil activation[J]. Am J Obstet Gynecol, 2013, 208(4):318.e1-318.e7.
[21]
Abenhaim HA, Azoulay L, Kramer MS, et al. Incidence and risk factors of amniotic fluid embolisms: a population-based study on 3 million births in the United States[J]. Am J Obstet Gynecol, 2008, 199(1):49.e1-49.e8.
[22]
Kramer MS, Rouleau J, Baskett TF, et al. Amniotic-fluid embolism and medical induction of labour: a retrospective, population-based cohort study[J]. Lancet, 2006, 368(9545):1444-1448.
[23]
Knight M, Tuffnell D, Brocklehurst P, et al. Incidence and risk factors for amniotic-fluid embolism[J]. Obstet Gynecol, 2010, 115(5):910-917.
[24]
Kramer MS, Rouleau J, Liu S, et al. Maternal Health Study Group of the Canadian Perinatal Surveillance System. Amniotic fluid embolsim: incidence, risk factors, and impact on perinatal outcome[J]. BJOG, 2012, 119(7):874-879.
[25]
Spiliopoulos M, Puri I, Jain NJ, et al. Amniotic fluid embolism-risk factors, maternal and neonatal outcomes[J]. J Matern Fetal Neonatal Med, 2009, 22(5):439-444.
[26]
Turillazzi E, Neri M, Bello S, et al. Amniotic fluid embolism: moving diagnosis through the time. From the mechanical pulmonary vascular occlusion until an immuno-inflammatory pathogenesis?[J]. Curr Pharm Biotechnol, 2014, 14(14):1179-1188.
[27]
Stawicki SP, Papadimos TJ. Challenges in managing amniotic fluid embolism: an up-to-date perspective on diagnostic testing with focus on novel biomarkers and avenues for future research[J]. Curr Pharm Biotechnol, 2014, 14(14):1168-1178.
[28]
Knight M, Tuffnell D, Brocklehurst P, et al. Incidence and risk factors for amniotic-fluid embolism[J]. Obstet Gynecol, 2010, 115(5):910-917.
[29]
McDonnell NJ, Percival V, Paech MJ. Amniotic fluid embolism: a leading cause of maternal death yet still a medical conundrum[J]. Int J Obstet Anesth, 2013, 22(4):329-336.
[30]
Kanayama N, Tamura N. Amniotic fluid embolism: pathophysiology and new strategies for management[J]. J Obstet Gynaecol Res, 2014, 40(6):1507-1517.
[31]
Cunningham FG, Leveno KJ, Bloom SL, et al. Williams Obstetrics[M]. 24th ed. New York: McGraw-Hill Professional, 2014:813.
[32]
Conde-Agudelo A, Romero R. Amniotic fluid embolism: an evidence-based review[J]. Am J Obstet Gynecol, 2009, 201(5):445.e1-445.e13.
[33]
Frati P, Foldes-Papp Z, Zaami S, et al. Amniotic fluid embolism: what level of scientific evidence can be drawn? A systematic review[J]. Curr Pharm Biotechnol, 2014, 14(14):1157-1162.
[34]
Leighton BL, Wall MH, Lockhart EM, et al. Use of recombinant factor VIIa in patients with amniotic fluid embolism: a systematic review of case reports[J]. Anesthesiology, 2011, 115(6):1201-1208.
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