41例妊娠期和产后脓毒症病例分析  

Analysis of 41 cases of sepsis during pregnancy and postpartum

作　　者：刘平[1] 樊尚荣[1] 梁轶珩[1] 刘小平[1] Liu Ping;Fan Shangrong;Liang Yiheng;Liu Xiaoping(Department of Obstetrics and Gynecology,Peking University Shenzhen Hospital,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院妇产科,深圳518036

出　　处：《中华产科急救电子杂志》2018年第3期174-179,共6页Chinese Journal of Obstetric Emergency（Electronic Edition）

基　　金：深圳重点学科建设能力提升项目(SZXJ201506038)

摘　　要：目的探讨妊娠期和产后脓毒症的临床及微生物学特征、治疗特点与母儿结局。方法回顾性研究2006年1月至2017年12月在北京大学深圳医院住院的妊娠期和产后脓毒症患者的临床资料,分析指标包括临床特征、微生物学特征、治疗情况及母儿结局。结果 41例妊娠期和产后脓毒症病例中13例(31. 7%)生殖系统感染,9例(21. 9%)泌尿系统感染,8例(19. 5%)呼吸系统感染;26例患者,血培养阳性(63. 4%),最常见的致病菌为大肠埃希菌(10株,35. 7%),患者住院时间7~61 d,平均为18 d。最常选用的抗生素为静脉滴注抗β-内酰胺酶抗生素(17例,41. 5%),其次是碳青霉烯类抗生素(13例,31. 7%),抗生素治疗时间6~61 d,平均为15 d。8例(19. 5%)患者需要外科手术干预。41例孕产妇中,39例治愈出院,2例患者死亡。围产儿结局中,分娩活婴22例,19例不良围产儿。结论妊娠期和产后脓毒症常导致不良妊娠结局,原发感染主要是生殖系统感染、泌尿系统感染和呼吸系统感染,最常见的感染细菌为大肠埃希菌;正确应用抗生素和必要时手术干预至关重要。Objective To explore the clinical features, microbial characteristics, treatment and pregnancy outcome of sepsis during pregnancy and postpartum. Methods A retrospective study was conducted in 41 cases of sepsis during pregnancy and postpartum, who were admitted to Peking University Shenzhen Hospital from January 2006 to December 2017. The analysis indexes included clinical features, microbial characteristics, treatment and pregnancy outcome. Results The sources of infection were genital tract infection （ 13 cases, 31.7% ）, urinary tract infection （ 9 cases, 21.9% ） and respiratory tract infection （8 cases, 19.5% ）. Twenty-six patients （63.4%） had positive blood culture, and the most common pathogenic bacteria was Eseheriehia eoli （ 10 strains, 35.7% ）. The length of hospital stay was 7 -61 days, with an average of 18 days. The most commonly used antibiotic was intravenous infusion of anti-beta-laetamase antibiotics （ 17 cases, 41.5% ） , followed by earbapenem antibiotics （ 13 cases, 31.7% ）. The duration of antibiotic treatment was 6 - 61 days, with an average of 15 days. Surgical intervention was required in 8 patients （19. 5% ）. Of the 41 cases, 39 patients were cured and 2 patients died. In the perinatal outcome, there were 22 live births and 19 poor perinatal infants. Conclusions Sepsis during pregnancy and postpartum often led to adverse pregnancy outcomes. Primary infections were genital tract infection, urinary tract infection and respiratory tract infection. Eseheriehia eoli was the most common bacteria. Correct use of antibiotics and surgical intervention are essential.

关 键 词：脓毒症 妊娠 高危 产褥期疾病 

分 类 号：R714.259[医药卫生—妇产科学] R714.626[医药卫生—临床医学]