283例入住重症监护病房救治的危重孕产妇的临床特征分析

doi:10.3969/j.issn.1674-8115.2021.05.012

摘要/Abstract

摘要：

目的·探讨入住重症监护病房（intensive care unit，ICU）救治的危重孕产妇的临床特征及死亡情况。方法·选择2007年1月—2018年12月于上海交通大学附属第一人民医院南院ICU救治的危重孕产妇283例。根据入住ICU的主要病因是否与妊娠相关，将患者分为妊娠并发症组（175例）和妊娠合并症组（108例）。采用统计学方法比较病例资料的组间差异。结果·妊娠并发症组孕产妇入住ICU的前3位病因依次是妊娠期高血压疾病、产科出血及妊娠剧吐导致的代谢紊乱，妊娠合并症组的前3位病因依次是妊娠合并心脏疾病、妊娠合并感染及妊娠合并急性胰腺炎。与妊娠合并症组相比，妊娠并发症组孕产妇的平均年龄较大、经产妇及未规律产检者较多、急性生理学与慢性健康评分Ⅱ（Acute Physiology and Chronic Health Evaluation Ⅱ，APACHE Ⅱ）分值较高，且进行内科穿刺操作（胸腔穿刺术、腹腔穿刺术、腰椎穿刺术、骨髓穿刺术）者较少（均P<0.05）。结论·危重孕产妇入住ICU的病因较多，深入分析该类孕产妇的临床特征将有助于ICU医师更好地认识和管理产科急危重症。

关键词: 危重孕产妇, 重症监护病房, 妊娠并发症, 妊娠合并症

Abstract:

Objective·To explore the clinical characteristics and mortality of maternal near miss admitted to intensive care unit (ICU).

Methods·A total of 283 maternal near miss admitted to ICU of Southern District of Shanghai General Hospital, Shanghai Jiao Tong University from January 2007 to December 2018 were selected. According to whether the main cause of ICU admission was related to pregnancy, the patients were divided into pregnancy complication group (175 cases) and pregnancy comorbidity group (108 cases). Statistical methods were used to compare the differences of the clinical data between the two groups.

Results·The top three diseases in the pregnancy complication group were hypertensive disorders complicating pregnancy, obstetric hemorrhage and metabolic disorders caused by hyperemesis gravidarum. The top three diseases in the pregnancy comorbidity group were pregnancy with heart disease, infection and acute pancreatitis. Compared with the pregnancy comorbidity group, the average age of pregnant and postpartum women in the pregnancy complication group was older, the number of multipara and irregular birth examination were more, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) was higher, and the number of medical puncture procedure (thoracentesis, abdominocentesis, lumbar puncture and bone marrow puncture) was less (all P<0.05).

Conclusion·There are many causes of ICU admission for maternal near miss. In-depth analysis of the clinical characteristics of this kind of pregnant women will help ICU physicians better understand and manage acute critical illness in obstetrics.

Key words: maternal near miss, intensive care unit (ICU), pregnancy complication, pregnancy comorbidity

中图分类号:

R459.7

侯一珺, 谢云, 王涛, 黄培杰. 283例入住重症监护病房救治的危重孕产妇的临床特征分析[J]. 上海交通大学学报(医学版), 2021, 41(5): 632-636.

Yi-jun HOU, Yun XIE, Tao WANG, Pei-jie HUANG. Analysis of clinical characteristics of 283 maternal near miss admitted to intensive care unit[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(5): 632-636.

图/表 4

参考文献 10

1	Pollock W, Rose L, Dennis CL. Pregnant and postpartum admissions to the intensive care unit: a systematic review[J]. Intensive Care Med, 2010, 36(9): 1465-1474.
2	The American College of Obstetricians and Gynecologists. ACOG practice bulletin No.211: critical care in pregnancy[J]. Obstet Gynecol, 2019, 133(5): e303-e319.
3	Bandeira AR, Rezende CA, Reis ZS, et al. Epidemiologic profile, survival, and maternal prognosis factors among women at an obstetric intensive care unit[J]. Int J Gynaecol Obstet, 2014, 124(1): 63-66.
4	白月婷, 刘亚杰, 赵怿, 等. 重度子痫前期紧急救治[J]. 中国临床医生杂志, 2019, 47(8): 910-912.
5	The American College of Obstetricians and Gynecologists. ACOG committee opinion No.767 summary: emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period[J]. Obstet Gynecol, 2019, 133(2): 409-412.
6	中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南(2020)[J].中华妇产科杂志, 2020, 55(4): 227-238.
7	Norton ME. What is new in the prevention of preeclampsia?[J]. Obstet Gynecol, 2016, 128(3): 651-652.
8	Sentilhes L, Merlot B, Madar H, et al. Postpartum haemorrhage: prevention and treatment[J]. Expert Rev Hematol, 2016, 9(11): 1043-1061.
9	Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis[J]. Lancet Glob Health, 2014, 2(6): e323-e333.
10	冯烨, 杨慧霞. 产后出血的早期识别和标准管理流程[J]. 中国临床医生杂志, 2019, 47(11): 1264-1268.

Index	Pregnancy complications group （n=175）	Pregnancy comorbidity group （n=108）	P value
Age/year	30.11±5.68	27.81±5.54	0.001
Gestation/week	31.59±4.91	33.13±5.80	0.116
Primipara/multipara/n	63/112	57/51	0.006
Irregular birth examination (<7 times)/n	77	32	0.016
Time of admission to ICU/d	4.39±3.48	5.46±3.50	0.166
APACHE Ⅱ/score	10.31±3.74	7.71±3.70	0.000
Death case/n	2	2	0.624

Index	Pregnancy complications group （n=175）	Pregnancy comorbidity group （n=108）	P value
Age/year	30.11±5.68	27.81±5.54	0.001
Gestation/week	31.59±4.91	33.13±5.80	0.116
Primipara/multipara/n	63/112	57/51	0.006
Irregular birth examination (<7 times)/n	77	32	0.016
Time of admission to ICU/d	4.39±3.48	5.46±3.50	0.166
APACHE Ⅱ/score	10.31±3.74	7.71±3.70	0.000
Death case/n	2	2	0.624

Disease	n
Hypertensive disorders complicating pregnancy	118
Severe preeclampsia	62
HELLP syndrome	27
Eclampsia	19
Cardiac failure	9
Posterior reversible encephalopathy syndrome	1
Obstetric hemorrhage	45
Postpartum hemorrhage	38
Placental abnormality	22
Uterine inertia	7
Coagulation disorders	6
Rupture of uterus	1
Soft birth canal injury	1
Vaginal wall hematoma	1
Ectopic pregnancy rupture and bleeding	7
Metabolic disorders caused by hyperemesis gravidarum	4
Amniotic fluid embolism	3
Acute fatty liver of pregnancy	1
Intrahepatic cholestasis of pregnancy	1
Twin-twin transfusion syndrome	1
Postabortal intrauterine infection/puerperal infection	2

Disease	n
Hypertensive disorders complicating pregnancy	118
Severe preeclampsia	62
HELLP syndrome	27
Eclampsia	19
Cardiac failure	9
Posterior reversible encephalopathy syndrome	1
Obstetric hemorrhage	45
Postpartum hemorrhage	38
Placental abnormality	22
Uterine inertia	7
Coagulation disorders	6
Rupture of uterus	1
Soft birth canal injury	1
Vaginal wall hematoma	1
Ectopic pregnancy rupture and bleeding	7
Metabolic disorders caused by hyperemesis gravidarum	4
Amniotic fluid embolism	3
Acute fatty liver of pregnancy	1
Intrahepatic cholestasis of pregnancy	1
Twin-twin transfusion syndrome	1
Postabortal intrauterine infection/puerperal infection	2

Disease	n
Pregnancy with heart disease	34
Pregnancy with congenital heart disease/myocarditis	16
Pregnancy with arrhythmia	17
Pregnancy with acute myocardial infarction	1
Pregnancy with infection	16
Pregnancy with severe pneumonia	4
Pregnancy with acute appendicitis	4
Pregnancy with urinary infection	3
Pregnancy with acute obstructive suppurative cholangitis	1
Pregnancy with cholecystitis	1
Pregnancy with brain abscess	1
Pregnancy with other infection	2
Pregnancy with acute pancreatitis	13
Pregnancy with epilepsy	8
Pregnancy with thyroid disease	5
Pregnancy with other perioperative period	4
Pregnancy with pulmonary embolism	3
Pregnancy with thoracocyllosis	3
Pregnancy with tumor (lymphoma, paranephros, liver)	3
Pregnancy with diabetic ketoacidosis	2
Pregnancy with asthma	1
Pregnancy with myasthenia gravis	1
Pregnancy with systemic lupus erythematosus	1
Pregnancy with cerebral thrombosis	1
Pregnancy with cerebral hemorrhage	1
Pregnancy with thrombocytopenia	1
Pregnancy with anaphylactic shock	1
Pregnancy with electrolyte disturbance	1
Other	9