羊水栓塞患者的凝血功能变化

摘要
图/表
参考文献(20)
相关文章 (2)

全文: PDF (921 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨羊水栓塞（AFE）患者的成分输血治疗及凝血功能变化趋势。方法回顾性分析2011年1月~2017年3月在南京医科大学附属苏州医院分娩并诊断为AFE的10例患者资料，分析其输注红细胞悬液、血浆、凝血酶原、血小板情况及凝血功能变化趋势。结果本研究纳入的10例AFE患者均发生了弥散性血管内凝血（DIC），分娩后24 h内平均出血量为（4065.6±1008.0）mL，输注红细胞悬液（16.6±7.2）U，输注血浆（2450.0±1250.3）mL，输注冷沉淀（8.4±7.3）U，输注纤维蛋白原（4.6±2.4）g，血小板的输注频率最低，仅2例患者输注了血小板。凝血指标在AFE发病2 h内发生急剧变化，及时止血、改善凝血功能后，各指标均在24 h左右恢复至正常水平，其中，凝血酶原时间恢复最快，在发病8 h左右恢复至正常水平；纤维蛋白降解产物和D二聚体恢复最慢，在发病后24 h左右恢复至正常水平；AFE发生后的血小板的低限约在50×109/L，基本可保证机体正常凝血需要，但恢复也较慢，在发病后72 h左右恢复至正常。结论 AFE发病后的2 h内是凝血系统急剧变化的时期，及时输注血液成分治疗可纠正DIC，并使凝血功能在24 h左右基本恢复至正常。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	岳永飞冯一奇▲ 汪云王晓艳

关键词 ：羊水栓塞, 弥散性血管内凝血, 凝血功能, 血小板

Abstract：Objective To investigate the blood transfusion treatment and the changes of coagulation function in patients with amniotic fluid embolism (AFE). Methods The data of 10 cases of patients with AFE treated in Suzhou Hospital Affiliated to Nanjing Medical University from January 2011 to March 2017 were analyzed retrospectively. The changes of infusion of erythrocyte suspension, plasma, prothrombin, platelet and coagulation function were analyzed. Results In this study, 10 cases of AFE patients had suffered from disseminated intravascular coagulation (DIC). In 24 hours after AFE, the average amount of bleeding was (4065.6±1008.0) mL, the infusion of red blood cell suspension was (16.6±7.2) U, the infusion of plasma was (2450.0±1250.3) mL, the infusion of cold precipitation was (8.4±7.3) U, the infusion of fibrinogen was (4.6±2.4) g, only two patients were infused with platelets. Coagulation index had rapid changes within 2 hours of AFE, the indicators were restored in 24 hours to normal levels after improving coagulation function. Time of prothrombin returned to normal levels in about 8 hours, which was the fastest. Fibrin degradation products and D-dimer recovery in about 24 hours, which were the slowest. The amount of platelets maintained at 50×109/L after AFE, which could ensure the normal blood clotting needs and returned to normal levels in about 72 hours, but the recovery was also slower. Conclusion Coagulation index had rapid changes within 2 hours of AFE, the timely infusion of blood components can improve DIC and coagulation return to normal in about 24 hours.

Key words： Amniotic fluid embolism Disseminated intravascular coagulation Coagulation Platelet

基金资助:江苏省苏州市妇产疾病临床医学中心项目（szzx201505）。

通讯作者: ▲通讯作者

引用本文:

岳永飞冯一奇▲ 汪云王晓艳. 羊水栓塞患者的凝血功能变化[J]. 中国医药导报, 2017, 14(27): 120-123,131.
YUE Yongfei FENG Yiqi▲ WANG Yun WANG Xiaoyan . The changes of coagulation in patients with amniotic fluid embolism. 中国医药导报, 2017, 14(27): 120-123,131.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2017/V14/I27/120

[1] 谢幸，苟文丽.妇产科学[M].8版.北京：人民卫生出版社，2013：215-218.
[2] Shamshirsaz AA，Clark SL. Amniotic fluid embolism[J]. Obstet Gynecol Clin North Am，2016，43（4）：779-790.
[3] Rath W H，Hoferr S，Sinicina I. Amniotic fluid embolism：an interdisciplinary challenge：epidemiology，diagnosis and treatment [J]. Dtsch Arztebl Int，2014，111（8）：126-132.
[4] Kramer MS，Rouleau J，Liu S，et al. Amniotic fluid embolism：incidence，risk factors，and impact on perinatal outcome [J]. BJOG，2012，119（7）：874-879.
[5] Indraccolo U，Battistoni C，Mastrantonio I，et al. Risk factors for fatality in amniotic fluid embolism：a systematic review and analysis of a data pool [J]. J Matern Fetal Neonatal Med，2017，3（1）：1-5.
[6] Kaaniche F M，Chaari A，Zekri M，et al. Amniotic fluid embolism complicating medical termination of pregnancy [J]. Can J Anaesth，2016，63（7）：871-874.
[7] Collins NF，Bloor M，Mcdonnell NJ. Hyperfibrinolysis diagnosed by rotational thromboelastometry in a case of suspected amniotic fluid embolism [J]. Int J Obstet Anesth，2013， 22（1）：71-76.
[8] Sultan P，Seligman K，Carvalho B. Amniotic fluid embolism：update and review [J]. Curr Opin in Anaesthesiol，2016， 29（3）：288-296.
[9] Clark SL，Romero R，Dildy GA，et al. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies [J]. Am J Obstet Gynecol，2016，215（4）：408-412.
[10] Nakagami H，Kajihara T，Kamei Y，et al. Amniotic components in the uterine vasculature and their role in amniotic fluid embolism [J]. J Obstet Gynaecol Res，2015，41（6）：870-875.
[11] Tamura N，Farhana M，Oda T，et al. Amniotic fluid embolism：Pathophysiology from the perspective of pathology [J]. J Obstet Gynaecol Res，2017，43（4）：627-632.
[12] 邹丽颖，范玲.羊水栓塞诊治进展[J].中国实用妇科与产科杂志，2011，27（2）：151-153.
[13] Levi M. Pathogenesis and management of peripartum coagulopathic calamities（disseminated intravascular coagulation and amniotic fluid embolism）[J].Thromb Res，2013， 131（3）：S32–S34.
[14] Kanayama N，Tamura N. Amniotic fluid embolism：pathophysiology and new strategies for management [J]. J Obstet Gynaecol Res，2014，40（6）：1507-1517.
[15] Knigllt M，Tuffnell D，Brocklehurst P，et al. Incidence and risk factom for amniotic—fluid embolism [J]. Obstet Gynecol，2010，115（5）：910-917.
[16] Sultan P，Seligman K，Carvalho B. Amniotic fluid embolism：update and review [J]. Curr Opin Anaesthesiol，2016，29（3）：288-296.
[17] Knight M，Berg C，Brocklehurst P，et al. Amniotic fluid embolism incidence，risk factors and outcomes：a review and recommendations [J]. BMC Pregnancy Childbirth，2012， 12（7）：1-11.
[18] Guillaume A，Sananes N，Akladios CY，et al. Amniotic fluid embolism：10-year retrospective study in a level III maternity hospital [J]. Eur J Obstet Gynecol Reprod Biol，2013，169（2）：189-192.
[19] Kanayama N，Tamura N. Amniotic fluid embolism：pathophysiology and new strategies for management [J]. J Obstet Gynaecol Res，2014，40（6）：1507-1517.
[20] Tanaka H，Katsuragi S，Osato K，et al. Value of fibrinogen in cases of maternal death related to amniotic fluid embolism [J]. J Matern Fetal Neonatal Med，2017，1（12）：1-4.