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患者女,26岁。因G_1P_0孕41周临产入院。既往史无异常。因产程停滞急诊,在连续硬膜外麻醉下行剖宫产术,胎儿取出顺利,Apgar10分。在胎盘取出时,发现血液颜色变暗,且病人出现寒战、胸闷、呼吸困难、血压下降至6/4kPa,考虑为羊水栓塞。立即给予面罩吸氧,静推地塞米松20mg、氨茶碱0.25g、麻黄碱20mg,开放两条静脉通路,滴注低分子右旋糖酐500ml、肝素100mg、多巴胺40mg和新鲜血液800ml,1h后发现子宫及附件有不疑固血渗出,查凝血时间30min(试管法),诊断为羊水栓塞并发DIC。立即给予全子宫切除,无明显渗血后盆腔放置引流管引流关腹。术毕患者神志清楚、呼吸平稳、血压13/8kPa,送回病房。继续给予吸氧、补液、强心、利尿、输新鲜血液和凝血因子、强效抗菌素(菌必治)等综合治疗。术后2d病情好转,10d后痊愈出院。
Female patient, 26 years old. Because G_1P_0 pregnant 41 weeks of labor admitted to hospital. Past no abnormalities. Stops due to labor emergency, cesarean section under continuous epidural anesthesia, fetus removed smoothly, Apgar10 points. When the placenta was removed, the blood color became dark and the patient developed chills, chest tightness, difficulty breathing and the blood pressure dropped to 6 / 4kPa, which was considered as amniotic fluid embolism. Immediately give the mask oxygen, intravenous dexamethasone 20mg, aminophylline 0.25g, ephedrine 20mg, open two venous access, infusion of low molecular weight dextran 500ml, heparin 100mg, dopamine 40mg and fresh blood 800ml, 1h after the discovery of the uterus And accessories have no doubt solid exudate, check coagulation time 30min (test tube method), diagnosis of amniotic fluid embolism complicated by DIC. Immediately give the whole hysterectomy, no significant bleeding after the pelvic drainage tube drainage Guan Yu. Patients completed surgery conscious, breathing steady, blood pressure 13 / 8kPa, returned to the ward. Continue to give oxygen, rehydration, cardiac, diuretic, lose fresh blood and clotting factors, potent antibiotics (bacteria must rule) and other comprehensive treatment. The condition improved after 2 days and was discharged after 10 days.