心跳骤停孕产妇发病原因及临床特点分析  

Analysis of the cause and clinical characteristics of maternal cardiac arrest

作　　者：黄天晴[2] 陈敦金[1] 刘慧姝[1] 戴满花[1] 黄东健[1] 

机构地区：[1]广州医学院第三附属医院产科,510150 [2]广州军区广州总医院妇产科,510010

出　　处：《中华妇产科杂志》2011年第10期742-747,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨孕产妇发生心跳骤停的发病原因及临床特点。方法对2005年1月至2009年12月广州医学院第三附属医院收治的41例心跳骤停孕产妇的临床资料进行回顾性分析。结果（1）一般情况：41例发生心跳骤停孕产妇中，6例发生在孕期，2例发生在第一产程，7例发生在第三产程，26例发生在产后。41例孕产妇中，12例心跳骤停发生在本院，29例发生在本院外（主要在基层医院）。本院同期分娩量为17101例，其心跳骤停的发生率为1：1425（12／17101）。心跳骤停发生至心肺复苏开始的时间在4min之内者35例。所有患者经初级心肺复苏均成功，最终存活12例（29％，12／41），死亡29例（71％，29／41）。（2）心跳骤停孕产妇的原发病因：41例孕产妇发生心跳骤停的原因按发病率高低依次是失血性休克12例（29％）、羊水栓塞7例（17％）、重度子痫前期及子痫7例（17％）、感染性休克6例（15％）、心脏病2例（5％）、原因不明2例（5％）、其他个别原因共5例（12％）。（3）41例孕产妇心跳骤停的发生地点：孕产妇心跳骤停发生在医院内者37例（90％），分别为手术室16例（39％），ICU7例（17％）、产科病房6例（15％）、产房5例（12％）和急诊科3例（7％）；发生在医院外者3例（7％），发生在救护车上1例（2％）。心跳骤停孕产妇中有3例发生在急诊科，其中2例存活，16例发生在手术室者8例存活，5例发生在产房者1例存活，6例发生产科病房者1例存活；而发生在ICU7例、院外3例以及救护车上1例最终均死亡。（4）存活孕产妇的神经系统损伤情况：共有12例孕产妇存活，其中5例（5／12）心跳骤停发生后出现缺血缺氧性脑病，1例发生大脑右侧放射冠脑梗死，其他6例无神经系统损伤。（5）心跳骤停发生在孕期和第一产程的8例孕产妇的围产儿结局：8例孕产妇中4例行围Objective To analyze the cause, and clinical characteristics of maternal cardiacarrest. Methods The data of all cases of maternal cardiac arrest from January 2005 to December 2009 in Third Affiliated Hospital of Guangzhou Medical College was retrospectively studied. Results （ 1 ） A total of 41 maternal cardiac arrests （6 in prenatal period, 2 in the first stage of labor, 7 in the third stage of labor, 26 in postpartum period ） were included. All patients regained spontaneous circulation after basic life support. Twelve （29%） mothers survived. Twelve cardiac arrests occurred in the hospital, and the total delivery number from January 2005 to December 2009 was 17 101, with occurrence rate of 1： 1425. （2） The causes of arrest were hemorrhagic shock （12, 29% ）, amniotic fluid embolism （7, 17% ）, severe preeclampsia/eclampsia （7, 17% ）, septic shock （6, 15% ）, cardiac disease （ 2, 5% ）, unidentified cause （2, 5% ） and other occasional causes. （3） Thirty-seven （90%） in-hospital maternal cardiac arrest occurred in operation room （16, 39% ）, ICU （7, 17% ）, maternity wards （6, 15% ）, delivery room （5,12% ） and the emergency room （ 3, 7% ）. Three （ 7% ） arrest occurred out of hospital and one in the ambulance. Maternal survival rate was 2/3 in the emergency room, 8/16 in the operation room, 1/5 in the maternity wards, and 1/6 in the delivery room. No mother survived in ICU, ambulance or out of hospital. （4） Five of the 12 survived women showed ischemic encephalopathy after cardiac arrest and one of them developed cerebral infarction in the right corona radiate. （ 5 ） In 4 of the 8 cases of cardiac arrest in pregnancy, perimortem caesarean section （PMCS） was performed. In the four PMCS, 2 mothers and 2 children survived. In the 4 cases that PMCS was not carried out,no infant survived. Conclusions Hemorrhagic shock, severe preeclampsia and eclampsia, amniotic fluid embolism are the major obstetric causes of maternal cardiac arrest. Septic s

关 键 词：妊娠并发症 心血管 心脏停搏 心肺复苏术 

分 类 号：R714.25[医药卫生—妇产科学]