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njlpkhgea
Wysłany: Sob 22:31, 19 Mar 2011
Temat postu: Latency of 152 cases of labor observed _4365
Latency of 152 cases of labor observed
6 patients, 4 of which were in the first or second stage of labor in the sudden appearance of chills, chest tightness, shortness of breath, irritability, general cyanosis, decreased or undetectable blood pressure instantly, the other 2 patients in the cesarean section and 30min after chest tightness, suffocation and cyanosis of lips,
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, blood pressure; to postpartum uterine bleeding difficult to control as the main performance of the 5 cases, blood loss was 2000-5000mL, accompanied the body skin, mucous membrane and eye of a needle bleeding in 3 cases, hematuria in 1 case. Acute renal failure in 2 cases, 1 case of acute heart failure. 1.3 Laboratory tests of platelet count 15s8 cases found in the amniotic fluid within the uterine artery after the visible elements in 3 cases. Comprehensive treatment of rescue measures 1.4 1.4.1: as the first symptom of pulmonary hypertension in patients to correct hypoxia, the lifting of the main pulmonary artery hypertension,
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, and immediately high flow oxygen mask in 3 cases,
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, tracheal intubation, positive pressure oxygen 3 cases, while giving the Ducks 30-9o papaverine bolus, atropine or aminophylline 0.25g lmg bolus plus 50% GS20mL slow bolus, 6 cases were 50-150mg with intravenous heparin anticoagulation and to plug Betamethasone 20-40mg anti-allergy treatment. With postpartum hemorrhage as the first symptom and pulmonary hypertension corrected bleeding was noted in 8 patients, all under the rapid blood transfusion in ECG monitoring, infusion of anti-shock, and in the application of heparin on the basis of positive complement coagulation factors, such as platelets,
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, fibrinogen, coagulation enzymes, if necessary, plus anti-fibrinolytic drugs such as 6 an aminocaproic acid, aromatic acid and other anti-fibrinolytic, and timely given the condition of patients to correct acidosis, correct heart failure, kidney failure and other treatment. 1.4.2 Maternity Care: Prenatal occurred in 4 cases of pulmonary hypertension in the oxygen and the correct house, while immediately cutting production in 2 cases, 2 cases of vaginal delivery; 11 patients, 4 patients in the hysterectomy, the uterus most resection in 2 cases, of which 2 cases were intra-abdominal bleeding 4 ~ 8h reoperation; keep the uterus in 4 cases, including a routine internal iliac artery and uterine artery ligation. 1.5 Results rescue was successful in all 11 patients, no complications, average length of stay 13.8d, newborn delivery, 13 cases were all survived. 2 2.1 Prevention of discussion: the occurrence of amniotic fluid embolism have some more incentive, the most common predisposing factors for premature rupture of membranes or artificial rupture of membranes, excessive uterine, cervical and pathologic Palace open sinus, great children , stillbirth, etc .... Comply with the above characteristics of this group of patients, 11 patients in 6 cases of fetal membranes rupture naturally, 2 of premature rupture of membranes, artificial rupture of membranes in 3 cases; 6 patients oxytocin oxytocin, induction of labor history, and 1 into the use of misoprostol vaginal labor induction; 1 case of uterine cesarean section because of twin difference to the sublingual misoprostol for uterine contraction; 1 case of acute production. Therefore, to prevent the occurrence of amniotic fluid embolism, obstetric physician must strictly adhere to oxytocin indications and contraindications, production process to reduce unnecessary intervention, to promote natural childbirth and avoid no indication and social factors leading to the planned delivery. 2.2 amniotic fluid embolism is the key to successful treatment of early detection, early diagnosis, early treatment, must have sufficient knowledge of the disease, emphasis on light and atypical symptoms, early treatment measures. The group 2 patients were in the first stage of labor and cesarean section mild chest tightness, chills, cyanosis, immediate hormone, theophylline and heparin therapy. Quickly alleviate the symptoms of postpartum blood loss was 400mL, 600mL, the other 1 case occurred in the second stage of a transient chills, Yuan chest tightness, cyanosis, it did not pay attention to, and post the short term DIC, shock. 2.3 adequate oxygen supply for the lifting of amniotic fluid embolism due to a necessary condition for pulmonary hypertension, amniotic fluid embolism and hypoxia-induced pulmonary hypertension, nasal oxygen catheter is difficult to correct, must be high flow oxygen mask or tracheal intubation is oxygen pressure to ensure the oxygen supply to improve the alveolar capillary hypoxia, reduced lung edema and pulmonary effusion, ease the heart, brain ischemia and acidosis induced by pulmonary artery spasm J. In the case of sufficient oxygen supply to the use of drugs relieve pulmonary hypertension,
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, hypoxia can rapidly improve. 2.4 The claim for the reasonable application of the liver necessary measures of amniotic fluid embolism 【successful. Early amniotic fluid embolism heparin can prevent or reduce the occurrence or development of DIC, heparin earlier onset of symptoms immediately after a small dose of heparin intravenously 25 ~ 5O Wow, without waiting for test results, after adjustment of heparin dosage according to the condition, so that test-tube Act HI time kept within 15 ~ 30min. DIC late should adopt an integrated
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