476例入住重症监护病房的危重孕产妇的临床特征  

Clinical characteristics of critically ill obstetric patients in intensive care unit： analysis of 476 cases

作　　者：汤雯婷 龚景进 匡丽云[1] 李秀英[1] 李晓梅[1] 潘燕梅[1] 杜丽丽[1] 苏春宏[1] 陈敦金[1] 

机构地区：[1]广州医科大学附属第三医院广州市重症孕产妇救治中心广东省产科重大疾病重点实验室,510150

出　　处：《中华围产医学杂志》2015年第10期732-736,共5页Chinese Journal of Perinatal Medicine

基　　金：基金项目：广东省协同创新平台（产科重大疾病防控协同创新中心）;广州市教育局协同创新重大项目（13xt04）;广州市科技惠民专项项目（2014Y2-00182）

摘　　要：目的探讨入住重症监护病房（intensivecareunit，ICU）的危重孕产妇的临床特征及其围产结局。方法对2009年6月至2014年6月在广州医科大学附属第三医院住院并分娩，且入住ICU的476例危重孕产妇的临床资料进行回顾性分析。根据危重孕产妇入住ICU的疾病谱分为产科原因组和非产科原因组，比较组间疾病构成及围产结局的差异。采用非参数Wileoxon秩和检验和矿检验进行统计学分析。结果入住ICU的危重孕产妇共476例，占5年总住院分娩量的1．71％（476／27836），平均年龄为（29．04±5．77）岁，平均孕周为（32．00±5．63）周。产科原因组占54．83％（261／476），非产科原因组占45．17％（215／476）。产科原因组人住ICU疾病谱前3位依次为妊娠期高血压疾病（35．29％，168／476）、产后出血（11．97％，57／476）和妊娠期急性脂肪肝（2．31％，11／476）。非产科原因组前3位为妊娠合并急性重型肝炎（7．56％，36／476）、妊娠合并重症肺炎（5．67％，27／476）和并列第3位的妊娠合并先天性心脏病（3．57％，17／476）与妊娠合并急性重症胰腺炎（3．57％，17／476）。产科原因组孕产妇年龄[（30．02±5．62）与（27．85±5．75）岁，Z=4．198，P=0．0001和未规律产前检查的比例高于非产科原因组[75．86％（198／261）与61．40％（132／215），z。11．603，P=0．001]。产科原因组孕产妇以急诊剖宫产终止妊娠常见（56．71％，148／261），而非产科原因组以病情稳定后择期剖宫产终止妊娠多见（45．58％，98／215）（x^2=21．990，P=0．000）。产科原因组病死率低于非产科原因组[1．53％（4／261）与6．98％（15／215），x^2=9．118，P=O．0031，子宫切除率[15．33％（40／261）与0．93％（2／215），矿=30．367，P=0．000]和新生儿窒息率高于非产科原因组[36．17％（102／282）与22．62％（50／221），x^2=10�Objective To explore the clinical characteristics of critically ill obstetric patients in intensive care unit （ICU） and the short-term perinatal outcomes. Methods The clinical data of 476 critically ill obstetric patients in ICU, who delivered in the Third Affiliated Hospital of Guangzhou Medical University from June 2009 to June 2014, were retrospectively analyzed. All subjects were divided into obstetric related diseases group （Group 1） and non-obstetric related diseases group （Group 2） according to the reasons for ICU admission. The perinatal outcomes of the two groups were compared by Wilcoxon-test and Chi-square test. ResultsTotally, 476 critically ill obstetric patients were transferred to ICU accounting for 1.71% of all deliveries during the 5-year period （476/27 836）, with the mean age of （29.04±5.77） years and the mean gestational age of （32.00±5.63） weeks. Among them, 261 women were assigned to Group 1 （54.83%） and 215 to Group 2 （45.17%）. The first three reasons for ICU admission in Group 1 were hypertensive disorder complicating pregnancy （35.29%, 168/476）, postpartum hemorrhage （11.97%, 57/476） and acute fatty liver of pregnancy （2.31%, 11/476） and those in Group 2 were pregnancy with acute severe hepatitis （7.56%, 36/476）, pregnancy with severe pneumonia 5.67%（27/476） and pregnancy with congenital heart disease （3.57%, 17/476） and pregnancy with acute severe pancreatitis （3.57%, 17/476） tie for the third place. The average age and the proportion of irregular prenatal care of the patients in Group 1 were both higher than those in Group 2 [（30.02 ± 5.62） vs （27.85 ± 5.75） years, Z=4.198, P=0.000; 75.86% （198/261） vs 61.40% （132/215）, x^2=11.603, P=0.001]. More than half of the pregnant women ended in emergency cesarean section （56.71%,148/261） in Group 1, while the most common delivery mode was elective cesarean section in Group 2 when patients were clinically stable （45.58%, 98/215） （x^2=21.990, P=0.000）. The

关 键 词：重症监护病房 危重病 孕妇 

分 类 号：R714.2[医药卫生—妇产科学]