摘要
目的 研究危重孕产妇收住重症监护病房（intensive care unit,ICU）的原因和高危因素. 方法 对2004年1月1日至2012年12月31日收住昆明医科大学第一附属医院ICU的、病历资料完整的174例危重孕产妇进行回顾性研究.按结局将这些孕产妇分为有严重妊娠并发症但没有生命危险情形的孕产妇（without life-threatening conditions,WLTC）、濒临死亡的孕产妇（maternal near-miss,MNM）和死亡孕产妇等3组.分析孕产妇死亡率、MNM发生率、MNM例数与孕产妇死亡例数之比,以及死亡指数等评价产科质量的指标.采用x2检验和Yates校正公式进行统计学分析. 结果 174例中,死亡孕产妇组6例（3.4％）,MNM组130例（74 7％）,WLTC组38例（21.8％）.分析发现,输注悬浮红细胞≥5单位[26.9％（35/130）]、因出血或感染切除子宫[14.9％ （19/130）]、血氧饱和度持续＜90％超过1 h[14.6％（19/130）]、重度子痫前期出现黄疸[10.0％（13/130）]和无法控制的全身抽搐[7.7％（10/130）]为本研究中MNM的主要诊断依据.妊娠期高血压疾病（包括重度子痫前期、子痫及溶血、肝酶升高和血小板减少综合征）为收住ICU的主要原因[36.1％（47/130）],其次为产科出血（包括产后出血和胎盘种植异常）[28.5％（37/130）],再次为妊娠合并心脏病[13.8％ （18/130）].研究期间,孕产妇死亡率为22.4/10万,MNM发生率为4.9‰,MNM与死亡孕产妇比例为21.7：1,死亡指数为4.4％.有生命危险情形的孕产妇（life-threatening conditions,LTC,指孕产妇死亡＋MNM）组有剖宫产史者、经产妇和无职业＋务农者高于WLTC组[分别为16.2％（22/136）与0.0％（0/38）、61.0％（83/136）与34.2％（13/38）以及85.3％（116/136）与55.2％ （21/38）,x2值分别为5.648、7.587和14.225,P值均＜0.05].LTC组输血比例、子宫切除比例、使用呼吸机的比例、总住院时间＞7 d的比例、剖宫产率和早产发生率均高于WLTC组[分别为68.4％（93/136）与7.8％（3/38）、19.1％（26/136）与0.0％（0/38）、58.1％ （79/136） 与7.9％（3/38）、70.6％（96/136） 与42.1％（16/38）、87.5％（119/136）与50.0％（19/38）、63.0％（85/136）与39.5％（15/3 8）],差异均有统计学意义（x2值分别为41.526、7.103、28.050、9.301、23 220和5.535,P值均＜0.05）. 结论 妊娠期高血压疾病和产科出血是MNM的主要原因.经产妇、无职业＋务农和有剖宫产史为危重孕产妇收住ICU的高危因素.
Objective To assess etiology and risk factors of obstetric patients of admitted to the Intensive Care Unit,First Affiliated Hospital of Kunming Medical University.Methods One hundred and seventy-four cases of obstetric patients admitted to the Intensive Care Unit during pregnancy or in the postpartum period were retrospectively classified into three groups：maternal without life threatening conditions （WLTC）,maternal near-miss （MNM）,and maternal death （MD）,according to their outcomes.The indicators for obstetrical criteria were evaluated.Chi-square test and Yates correlated formula were used for statistical analyses.Results Among the 174 patients,6 patients（3.4％） were deceased,130 cases （74.7％） were maternal near-miss,and 38 cases （21.8％） were in without potentially life threatening conditions.Main clinical manifestations of MNM were infusion of erythrocyte suspension ≥ 5 U（26.9％,35/130）,hysterectomy due to hemorrhage or infection （14.9％,19/130）,pulse oximetry lower than 90％ for more than one hour （14.6％,19/130）,jaundice in severe preeclampsia （10.0％,13/130） and uncontrollable convulsions （7.7％,10/130）.Main complications of MNM were maternal hypertension （including preeclampsia,severc prccclampsia and hemodialysis,elevated liver enzymes and low platelet levels syndrome）,which was 36.1％（47/130）,following by obstetrical hemorrhage （28.5％,37/130） and heart diseases （13.8％,18/130）.Maternal mortality rate was 0.224％‰,incidence rate of MNM was 4.9％‰,MNM/maternal death was 21.7：l,and the death index was 4.4％.Multiparity,previous caesarean section and jobless in life threatening （LTC,i.e.MD ＋ MNM） group were higher than those in the WLTC group [16.2％（22/136） vs 0.0％（0/38）,x2=5.648; 61.0％（83/136） vs 34.2％（13/38）,x2=7.587; 85.3％（116/136） vs 55.2％（21/38）,x2=14.225; all P ＜ 0.05].Transfusion,hysterectomy,mechanical ventilation,length of stay ＞7 days,caesaraen section and preterm delivery in LTC group were higher than those in WLTC group [68.4％（93/136） vs 7.8％（3/38）,x2=41.526; 19.1％（26/136） vs 0.0％（0/38）,x2=7.103; 58.1％（79/136） vs 7.9％（3/38）,x2=28.050; 70.6％（96/136） vs 42.1％（16/38）,x2=9.301; 87.5％（119/136） vs 50.0％（19/38）,x2=23.220;63.0％（85/136） vs 39.5％（15/38）,x2=5.535; all P ＜ 0.05].Conclusions Hypertensive disorders in pregnancy and obstetric hemorrhage are main causes for obstetric patients admitted to the ICU.Multiparity,previous caesarean section and jobless are risk factors of obstetric patients admitted to the ICU.
出处
《中华围产医学杂志》
CAS
CSCD
2015年第2期101-106,共6页
Chinese Journal of Perinatal Medicine
关键词
重症监护病房
高血压
妊娠性
产后出血
危重病
妊娠结局
Intensive care units
Hypertension,pregnancy-induced
Postpartum hemorrhage
Critical illness
Pregnancy outcome
