目的 分析医院门诊西药房“分-全带教”模式的应用效果,为提高药房实习生的教学质量提供参考价值。方法 选取广州市番禺区中心医院药学部门诊西药房2020年9月—2022年7月的48例实习生（包含进修生、研究生）作为研究对象,对所有实习生实施“分阶段、分层级、分诊断单元窗口学习、全面能力培养”的“分-全带教”模式。观察所有实习生入科实习前后的考核成绩。结果 通过“分-全带教”实施后,实习生的理论知识（94.15±3.38）分、药学服务技能评分（90.56±3.99）分均比实习前有所提升,且实习生的学习兴趣（94.21±3.70）分、巩固知识点（91.98±3.56）分、提高医患沟通（92.73±3.81）分、认识自身技能不足（92.06±3.50）分同时提升（P<0.05）。结论 采用“分-全带教”模式明显提升对医院门诊西药房的实习生中的教学效果,实习生的理论和实践技能均有所提高,其药学服务能力同时得到提高。

Objective To analyze the application effectiveness of the “divided-comprehensive precepting” model in the hospital outpatient pharmacy and provide reference value for improving the teaching quality of pharmacy interns．Methods Forty-eight interns（including visiting scholars and graduate students）from the Pharmacy Department of Panyu Central Hospital in Guangzhou,China,from September 2020 to July 2022 were selected as the research subjects．The “divided-comprehensive precepting” model,characterized by “staged,tiered,diagnosis unit-specific window learning,and comprehensive competency development” was implemented for all interns．The scores of all interns before and after entering the internship were observed．Results After the implementation of the“divided-comprehensive precepting”model,the scores of interns in theoretical knowledge（94.15±3.38）and pharmaceutical service skills（90.56±3.99）were improved compared to those before the internship．Moreover,interns’scores in learning interest（94.21±3.70）,consolidating knowledge（91.98±3.56）,enhancing doctor-patient communication（92.73±3.81）and recognizing their own skill deficiencies（92.06±3.50）were also improved．Conclusions The “divided-comprehensive precepting” precepting model significantly enhances the teaching effectiveness in the internship of hospital outpatient pharmacy．Interns’ theoretical and practical skills are improved,enhancing their pharmaceutical service capabilities．

目的 探讨基于态度-定义-开放思维-计划-实施（ADOPT）模式的健康教育联合情绪引导对消化内镜诊疗患者配合度的影响。方法 选取2020年1月—2023年1月在我院准备行消化内镜诊疗的80例住院患者,随机分为观察组与对照组各40例。对照组患者在检查前采取常规护理,观察组患者在常规护理基础上增加基于ADOPT模式的健康教育联合情绪引导,在护理前后应用简明心境量表（POMS-SF）分别评估两组患者负面情绪、诊疗配合度、基础值（T₁）、入镜时（T₂）、检查开始后5 min（T₃）、检查结束时（T₄）的Ramsay镇静评分和舒适度评分,并对比两组患者的护理满意度。结果 护理后两组患者的困惑、活力、疲劳、抑郁、生气和紧张方面的POMS-SF评分降低,且观察组低于对照组（P<0.05）;观察组患者配合度为95.00%,高于对照组75.00%（P<0.05）;两组患者T1时间Ramsay镇静评分与舒适度评分比较差异无统计学意义（P>0.05）,观察组T₂、T₃、T₄时间Ramsay镇静评分高于对照组,舒适度评分优于对照组（P<0.05）;观察组患者的总满意度高于对照组（P<0.05）。结论 对消化内镜诊疗患者采取基于ADOPT模式的健康教育联合情绪引导可改善患者内镜诊疗过程前的负面情绪,提升患者配合度,同时能够改善患者诊疗过程中的镇静程度和舒适度,患者护理满意度较高。

Objective To explore the value of health education based on the ADOPT model combined with emotional guidance on the cooperation of patients undergoing digestive endoscopy diagnosis and treatment．Methods From January 2020 to January 2023,80 hospitalized patients who were going to have digestive endoscopy diagnosis and treatment in our hospital were selected as the research subjects．All patients were divided into observation group and control group,with 40 patients in each group．The control group patients received routine care before the examination,while the observation group patients added ADOPT based health education combined with emotional guidance on the basis of routine care．The Profile of Mood States-Short Form（POMS-SF）was used to evaluate the negative emotions of the two groups of patients before and after the examination．The diagnostic and treatment cooperation,basic value（T₁）,at the time of endoscopy（T₂）,and 5 minutes after the examination（T₃）,at the end of the examination（T₄）,the Ramsay sedation score and comfort score were compared between the two groups,and the nursing satisfaction of the two groups of patients was compared．Results After nursing,the POMS-SF scores of confusion,vitality,fatigue,depression,anger,and tension in the two groups of patients were significantly reduced,and the observation group was lower（P<0.05）．The cooperation rate of 95.00% in the observation group was significantly higher than that of 75.00% in the control group（P<0.05）．There was no significant difference in the Ramsay sedation score and comfort score between the two groups of patients at T₁ time（P>0.05）．The Ramsay sedation scores of the observation group at T₂,T₃,and T₄ time were higher,while the comfort score was lower（P<0.05）．The overall satisfaction of the observation group patients was higher（P<0.05）．Conclusions Adopting ADOPT based health education combined with emotional guidance for patients undergoing endoscopic diagnosis and treatment can improve their negative emotions before the endoscopic diagnosis and treatment process,enhance their cooperation level,and improve their level of sedation and comfort during the process．Patients have a high level of nursing satisfaction．

目的 探讨多学科整合护理路径联合手术室优质护理对下肢骨折的应用效果及对术后下肢静脉血栓发生率的影响。方法 选择2021年1月—2022年10月我院收治的70例下肢骨折患者,随机分为联合组与常规组,每组各35例。常规组患者实施常规护理,联合组患者实施多学科整合护理路径联合手术室优质护理,对比两组患者护理效果。结果 联合组患者首次下床活动时间、术后视觉模拟量表（VAS）评分低于常规组（P<0.05）,二者住院时间以及引流管拔除时间比较差异无统计学意义（P>0.05）;经过护理干预后,两组的凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）均延长,血浆纤维蛋白原（FIB）降低,联合组优于常规组（P<0.05）,且联合组下肢静脉血栓发生率低于常规组（0% vs 17.14%,P<0.05）;联合组患者护理满意度更高（P<0.05）;术后1个月两组患者日常生活活动能力（ADL）评分、Fugl-Meyer评分均升高,联合组高于常规组（P<0.05）。结论 多学科整合护理路径联合手术室优质护理可改善下肢骨折患者围术期指标和血液高凝状态,降低患者下肢静脉血栓发生率,提升护理满意度及患者远期日常生活能力、肢体运动功能。

Objective To explore the application effect of multidisciplinary integrated nursing path combined with high-quality nursing in operating room on patients with lower limb fracture and the effect on postoperative lower limb venous thrombosis．Methods From January 2021 to October 2022,70 patients with lower limb fracture admitted to our hospital were randomly divided into combination group and conventional group,with 35 cases in each group．Patients in the conventional group received routine nursing,and patients in the combined group received multidisciplinary integrated nursing path combined with high-quality nursing in the operating room．The nursing effect of the two groups was compared．Results The first time of getting out of bed in the combined group was earlier and postoperative VAS score was lower than those in the conventional group（P<0.05）,and the length of hospital stay and drainage tube removal time were not significantly different between the two groups（P>0.05）．After nursing intervention,the prothrombin time（PT）and activated partial thromboplastin time（APTT）of the two groups were prolonged,and the plasma fibrinogen（FIB）decreased,and the change range of the combined group was greater（P<0.05）．The incidence of venous thrombosis in the combined group was significantly lower than that in the conventional group（0.00% vs 17.14%,P<0.05）．The nursing satisfaction of patients in combination group was higher（P<0.05）．The activities of daily living score and Fugl-Meyer score of both groups increased one month after surgery,and the combined group was higher than the conventional group（P<0.05）．Conclusions Multidisciplinary integrated nursing path combined with high-quality nursing in operating room can improve perioperative indicators and blood hypercoagulability of patients with lower limb fractures,reduce the incidence of lower limb venous thrombosis,improve nursing satisfaction,long-term daily living ability and limb motor function of patients．

目的 分析阿莫西林克拉维酸钾与第三代头孢类抗菌药联合应用于新生儿肺炎患儿的应用效果及其对患儿肠道菌群的影响。方法 选择在2021年2月—2022年11月期间于我院新生儿科接受相关治疗的100例新生儿肺炎患儿,依照简单随机化法将患儿分为研究组（n=50）及参照组（n=50）。给予参照组常规新生儿肺炎治疗,在此基础上给予研究组患者阿莫西林克拉维酸钾与第三代头孢类抗菌药的联合治疗。治疗结束后对比两组患儿的血清因子水平、肠道菌落情况、临床疗效以及不良反应发生情况。结果 治疗前,两组患儿的血清因子水平、肠道内菌群数量比较差异无统计学意义（P>0.05）,治疗后两组患儿的降钙素原（procalcitonin,PCT）、C-反应蛋白（C-reactive protein,CRP）、白细胞计数（white blood cell count,WBC）、肠球菌、肠杆菌、双歧杆菌以及乳酸杆菌水平均有改善（P<0.05）,其中研究组的PCT、CRP、WBC、肠球菌、双歧杆菌以及乳酸杆菌数量低于参照组,而研究组的肠杆菌数量高于参照组;同时研究组的临床有效率（94.00%）与参照组的临床有效率（86.00%）比较差异无统计学意义（P>0.05）;两组患儿的不良反应发生率比较差异无统计学意义（P>0.05）,但其中研究组腹泻的发生率高于参照组（P<0.05）。结论 在对新生儿肺炎患儿进行治疗时采取阿莫西林克拉维酸钾单纯治疗与阿莫西林克拉维酸钾+第三代头孢类抗菌药（头孢他啶）的临床疗效相当,联合用药虽能更为显著地减少患儿机体的细菌数量,改善血清因子水平,但更易发生腹泻的并发症,且为了减少耐药性,应适当采用单独用药。

Objective To analyze the application effect of amoxicillin clavulanate potassium combined with third-generation cephalosporin antibiotics in children with neonatal pneumonia and its impact on the intestinal microbiota．Methods From February 2021 to November 2022,100 newborns with pneumonia who received relevant treatment in the Department of Neonatology at the First People’s Hospital of Shangqiu City were randomly divided into a study group（n=50）and a reference group（n=50）using a simple randomization method．Routine treatment was provided for neonatal pneumonia in the reference group,and on this basis,a combination treatment of amoxicillin,clavulanate potassium,and third-generation cephalosporin antibiotics was applied on the study group patients．After treatment,the serum factor levels,intestinal colony status,clinical efficacy,and incidence of adverse reactions were compared between the two groups of children．Results Before treatment,there were no statistically significant differences in serum factor levels and intestinal microbiota between the two groups of children（P>0.05）．After treatment,the levels of procalcitonin（PCT）,C-reactive protein（CRP）,white blood cell count（WBC）,Enterococcus,Enterobacter,Bifidobacterium,and Lactobacillus in the two groups of children improved（P<0.05）,with the levels of PCT,CRP,WBC,the number of Enterococcus,Bifidobacterium,and Lactobacillus in the study group was lower than that in the reference group,while the number of Enterobacter in the study group was higher．There was no statistically significant difference（P>0.05）in the clinical response rate between the study group（94.00%）and the reference group（86.00%）．There was no statistically significant difference in the incidence of adverse reactions between the two groups of children（P>0.05）,but the incidence of diarrhea in the study group was higher than that in the reference group（P<0.05）．Conclusions The clinical efficacy of amoxicillin clavulanate potassium alone and amoxicillin clavulanate potassium+third-generation cephalosporin antibiotics（ceftazidime）in the treatment of newborns with pneumonia is comparable．Although the combination therapy can significantly reduce the number of bacteria in the body of children and improve serum factor levels,it is more prone to complications of diarrhea．In order to reduce drug resistance,separate medication should be appropriately used．

目的 探讨积极综合护理措施对早期宫颈癌术后患者性功能、抑郁和主观幸福感的影响。方法 对我院收治的84例50岁以下宫颈癌患者的临床资料进行回顾性分析,将行常规护理的43例患者作为对照组、行综合护理的41例患者作为治疗组,治疗组除了常规护理内容,还采用幸福理论框架模型下（PERMA模型）的性健康管理多学科团队干预方案。分别在干预前、干预后3个月、干预后6个月采用女性性功能指数、抑郁自评量表评分和幸福感指数,对性功能指数、抑郁评分和幸福指数进行评估。结果 与对照组相比,治疗组干预3个月及6个月患者的性功能改善（F=91.08,P<0.001）。干预3个月及6个月后,治疗组抑郁评分低于对照组（F=1 092.59,P<0.001）,幸福感改善指数高于对照组（F=107.90,P<0.001）。Spearman相关分析结果显示,女性性功能指数同抑郁自评量表得分呈负相关（r_s=-0.918,P<0.001）,同幸福感指数得分呈正相关（r_s=0.844,P<0.001）。结论 综合护理在性功能、抑郁和主观幸福感方面均有明显改善。通过PERMA模式下性健康管理的多学科团队干预方案,可以提高患者的性生活质量,降低患者的抑郁程度,及改善患者的主观幸福感。

Objective To explore the effects of active and comprehensive care measures on sexual function,depression and subjective well-being of patients after early cervical cancer surgery．Methods The clinical data of 84 cervical cancer patients（under 50 years old）admitted to our hospital were retrospectively analyzed．There were 43 cases with conventional care in control group and 41 cases with comprehensive care group in treatment group．Besides the conventional care components,the comprehensive care group also adopted a multidisciplinary team intervention program for sexual health management under the framework model of well-being theory（PERMA model）．We used the female sexual function index,depression self-rating scale score and happiness index to assess the sexual function index,depression score and happiness index before,3 months and 6 months after the intervention,respectively．Results In comparison with the control group,the patients in the treatment group had a significant improvement in sexual function at 3 and 6 months of intervention（F=91.08,P<0.001）．After 3 and 6 months of intervention,the depression score was significantly lower in the comprehensive care group than in the control group（F=1 092.59,P<0.001）,and the happiness improvement index was significantly higher than in the control group（F=107.90,P<0.001）．Spearman’s correlation analysis showed that the female sexual function index was negatively correlated with the depression self-rating scale score（r_s=-0.918,P<0.001）and positively correlated with the well-being index（r_s=0.844,P<0.001）．Conclusions The comprehensive care group showed significant improvements in sexual function,depression,and subjective well-being．A multidisciplinary team intervention program for sexual health management under the PERMA model can improve the quality of patients’ sexual life,reduce their depression,and improve their subjective well-being．

目的 探讨近端和远端结直肠无蒂锯齿状病变在临床和内镜特征上的区别。方法 回顾性分析103例结直肠无蒂锯齿状病变患者的临床内镜资料,对近端和远端结直肠无蒂锯齿状病变患者在性别、年龄、内镜特征（息肉大小、山田分型、内镜NICE分型、蛇形微血管、黏液帽）等方面进行比较。结果 与远端结直肠无蒂锯齿状病变相比,近端结肠无蒂锯齿状病变发病年龄更早（P=0.014）,内镜下山田1型息肉更为常见（P=0.050）,黏液帽也是近端结肠无蒂锯齿状病变的重要内镜特征（P<0.001）。结论 近端无蒂锯齿状病变内镜下扁平隐匿,容易漏诊,掌握其内镜特征有助于提高该病的检出率。

Objective To explore the differences in clinical and endoscopic characteristics of sessile serrated lesions in the proximal and distal colorectum．Methods The clinical endoscopic data of 103 patients with sessile serrated lesions of the colorectum were retrospectively analyzed．The gender,age and endoscopic features（polyp size,Yamada classification,NICE classification,dilate vessels and the mucus cap）of patients with proximal and distal colorectal sessile serrated lesions were compared retrospectively．Results Compared with distal colorectal sessile serrated lesions,the age of onset of proximal colon sessile serrated lesions was earlier（P=0.014）,endoscopic Yamada type 1 polyps were more common（P=0.050）,and mucus cap was also an important endoscopic feature of proximal colon sessile serrated lesions（P<0.001）．Conclusions The proximal sessile serrated lesions are flat and hidden under endoscopic examination which are easily missed．Understanding their endoscopic characteristics can help improve the detection rate of the disease．

目的 通过学习1例少见的组织学特征与IgG4相关性淋巴结病类似的浆细胞型特发性多中心型Castleman病（PC-iMCD）,总结两种易误诊疾病的鉴别要点,提高病理诊断水平。方法 回顾性分析1例PC-iMCD患者临床资料,常规苏木素-伊红（HE）染色分析淋巴结组织结构及细胞形态,免疫组织化学染色及原位杂交分析免疫表型及EB病毒（EBV）感染状态,并结合文献分析讨论其与IgG4相关淋巴结病的鉴别诊断。结果 48岁女性患者,临床表现为口干、多饮、皮肤瘙痒伴全身多处淋巴结肿大。实验室检查血清IgG、IgA、IgM及IgE水平均升高,血清IgG4显著升高（14.7 g/L）,白介素- 6（IL-6）异常升高（150.84 pg/mL）。病理检查显示淋巴结生发中心萎缩,套区淋巴细胞呈“洋葱皮”样围绕生发中心排列,滤泡间区扩张,其内见大量成熟的浆细胞呈片状浸润,灶区见含铁血黄素沉积及血管增生;免疫组化染色显示IgG4阳性浆细胞数大于100/高倍视野,IgG4阳性细胞/IgG阳性细胞比值>40%,Kappa及Lambda轻链呈非限制性表达;EB病毒编码RNA原位杂交（EBER）阴性。结论 部分PC-iMCD与IgG4相关淋巴结病具有相似的组织病理学特征,单纯根据组织学及免疫表型难以将两者鉴别,正确诊断需结合IgG4相关病变诊断标准、排除性诊断标准、临床表现及实验室检查综合判断。

Objective By studying a rare case of the plasma cell type idiopathic multicentric Castleman disease（PC-iMCD）with histological characteristics similar to IgG4-related lymphadenopathy,the differential points of the two easily misdiagnosed diseases were summarized to improve the level of pathological diagnosis．Methods The clinical data of one patient with PC-iMCD were collected,the structure alteration and cell morphology were observed by hematoxylin-eosin（HE）stains．The immunophenotype of cells was marked by immunohistochemical staining and the infections status of EB virus was detected by in situ hybridization．Besides,the differential diagnosis between IgG4-RD and PC-iMCD were analyzed and discussed based on literature analysis．Results This article reported a 48-year-old female who was admitted to the hospital with dry mouth,polydipsia,skin itching and multiple lymphadenopathy．The levels of various classes of serum immunoglobulin were all increased,such as IgG,IgA,IgM and IgE．Specially,the serum IgG4 was also significantly increased（14.7 g/L）and interleukin 6（IL-6）was abnormally raised（150.84 pg/mL）．The pathological examination indicated that the lymph node germinal center was atrophied and mantle zones were expanded which were composed of concentric rings of lymphocytes in an “onion skinning” appearance．Besides,the interfollicular area was expanded in which mature plasma cells were infiltrated in sheet-like,hemosiderin was deposited as well as the vessels were proliferated．Immunohistochemistry showed that the number of IgG4-positive plasma cells was >100/HPF,IgG4/IgG-positive cells ratio was >40%,and Kappa and Lambda light chains were expressed unrestrictedly．In situ hybridization revealed that the expression of EBER was negative．Conclusions PC-iMCD and IgG4-related lymphadenopathy shares similar histopathological characteristics and it’s challenging to distinguish these two diseases by their histology and immunophenotype．In conclusion,the correct diagnosis should be combined with the diagnostic criteria,exclusion diagnostic criteria,clinical manifestations and related laboratory examinations．

目的 观察低浓度布比卡因联合全身麻醉在腹腔镜下直肠癌根治术中的应用及对患者体征及苏醒质量的影响。方法 选择2020年1月—2021年6月在信阳一五四医院实施腹腔镜镜下直肠癌根治术治疗的126例直肠癌患者为研究对象,通过抽签法对患者进行分组,将其中63例列为全麻组,术中单纯实施全身麻醉,其余63例列为联合组,术中采用低浓度布比卡因联合全身麻醉,比较两组患者体征变化情况,苏醒质量,麻醉相关不良反应,并开展为期1.5年的随访,评估两组患者远期生存质量。结果 联合组术中、术后的心率、平均动脉压均低于全麻组（P<0.05）;术后,联合组的Steward麻醉苏醒评分略低于全麻组、麻醉恢复室停留时间略高于全麻组（P>0.05）;但联合组的视觉模拟疼痛评分、镇静评分均低于全麻组（P<0.05）;联合组的麻醉相关不良反应发生率略高于全麻组（P>0.05）;随访期间,联合组的肠癌患者生存质量测定量表各维度评分均高于全麻组（P<0.05）。结论 低浓度布比卡因联合全身麻醉的麻醉效果更加平稳、安全性高。

Objective To observe the application of low concentration bupivacaine combined with general anesthesia in laparoscopic radical resection of rectal cancer and its effect on the physical signs and recovery quality of patients. Methods In this study,126 rectal cancer patients who underwent laparoscopic radical resection of rectal cancer in Xinyang 154th Hospital from January 2020 to June 2021 were selected as the research subjects．The patients were divided into groups by drawing lots．Among them,63 patients were included in general anesthesia group,and the rest 63 patients were included in combined group．Low-concentration bupivacaine combined with general anesthesia was used in combined group during the operation．The changes of physical signs and the quality of recovery were compared between the two groups．Anesthesia related adverse events,and the long-term quality of life of the two groups of patients was evaluated through one-year and a half follow-up. Results The heart rate and mean arterial pressure during and after surgery in the combined group were lower than those in the general anesthesia group（P<0.05）．After surgery,the Steward anesthesia recovery score of the combined group was slightly lower than that of the general anesthesia group,and the PACU stay time was slightly higher than that of the general anesthesia group（P>0.05）．However,the VAS score and Richmond Agitation-Se dation Scale score of the combined group were lower than those of the general anesthesia group（P<0.05）．The incidence of anesthesia related adverse reactions in the combination group was slightly higher than that in the general anesthesia group（P>0.05）．During the follow-up period,the FACT-C scores of all dimensions in the combination group were higher than those in the general anesthesia group（P<0.05）. Conclusions The anesthesia effect of low concentration bupivacaine combined with general anesthesia is significant and safe．

目的 探讨耳内镜下超薄耳屏软骨-软骨膜修补鼓膜大穿孔的效果。方法 回顾性分析31例应用超薄耳屏软骨-软骨膜行耳内镜下夹层法鼓膜修补术的患者资料,随访6个月,分析术后鼓膜愈合率、听力恢复情况。结果 30例鼓膜愈合,成功率96.8％,无移植物外移、内陷、钝角愈合;术前平均气导听阈为（38.3±3.3）dB HL,骨气导差为（23.5±3.1）dB HL,术后平均气导听阈为（22.3±1.6）dB HL,骨气导差为（6.3±2.5）dB HL,听力较术前提高（P<0.001）。结论 超薄耳屏软骨-软骨膜在耳内镜下鼓膜大穿孔修补术中效果较好,并发症少,是可靠的修复材料,值得临床推广应用。

Objective To investigate the clinical efficacy of endoscopic ultrathin tragus cartilage-perichondrium as graft material for treatment of large tympanic membrane perforations. Methods A total of 31 cases（31 ears）which were diagnosed as chronic suppurative otitis with large tympanic membrane perforation were performed endoscopic myringoplasty with ultrathin tragus cartilage-perichondrium by sandwich technique．The pure tone threshold average（PTA）of speech frequency and the air-bone gap were assessed at 6 month safter surgery. Results Successful closure without reperforation was obtained in 30 of 31 patients（96.8%）．There was no graft lateralization,anterior blunting ．Average postoperative air conduction and bone-air conduction gap were（22.3±1.6）dB HL and（6.3±2.5）dBHL compared with（38.3±3.3）dB HL and（23.5±3.1）dB HL preoperatively（P<0.001）. Conclusions The ultrathin tragus cartilage-perichondrium is liable repair material for large tympanic membrane perforation with excellent graft take and significant improvement of hearing,which is worthy of clinical promotion．

目的 分析我院羊水栓塞患者的临床资料及诊治经过,总结羊水栓塞致弥散性血管内出血（DIC）患者输血治疗救治经验。方法 回顾性分析2016年1月1日—2022年12月31日在广州医科大学附属第二医院番禺院区分娩并发羊水栓塞患者的症状、实验室辅助检查、用药诊治经过及妊娠结局。结果 在6 104次孕晚期分娩记录中,共发生3例羊水栓塞,高龄产妇1例、经产妇2例、多产1例。3例均并发DIC,产后出血1 500~3 000 mL。其中1例行子宫切除术,2例保留子宫,均抢救成功,无患者死亡。结论 根据有限数据推论羊水栓塞罕见、凶险,病情进展快,多继发产后出血、DIC,主要依靠临床表现进行诊断,早期识别诊断和处理,产科快速反应团队及多学科协作,给予高级生命支持,有效止血并科学地成分输血纠正凝血功能障碍及DIC,是改善孕产妇结局的关键。

Objective To analyze the clinical data,diagnosis and treatment of patients with amniotic fluid embolism in our hospital,and to summarize the experience of blood transfusion treatment for disseminated intravascular coagulation（DIC） patients with amniotic fluid embolism. Methods From January 1,2016 to December 31,2022,the symptoms,laboratory tests,drug treatments and pregnancy outcomes of patients with amniotic fluid embolism during delivery in Panyu Hospital,the Second Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. Results There were 3 cases of amniotic fluid embolism in 6 104 late pregnancy records,accounting for 1/3 of the elderly parturients,2/3 of the multiparas and 1/3 of the prolific parturients．All three cases had DIC and postpartum hemorrhage of 1 500-3 000 mL．Among them,1 case underwent hysterectomy and 2 cases saved the uterus,all of which were successfully rescued without death. Conclusions Amniotic fluid embolism is rare,dangerous disease with rapid progression,often followed by secondary postpartum hemorrhage and DIC,and mainly relies on clinical manifestations for diagnosis．Early identification,diagnosis and treatment,rapid response team in obstetrics and multidisciplinary collaboration,advanced life support,effective hemostasis and scientific component blood transfusion to correct coagulation dysfunction and DIC,are the keys to improve maternal outcomes．