不同ICU入院方式危重孕产妇临床特征研究——来自大学医院2006至2019年的数据分析  

Clinical characteristics of critically ill pregnant women with different admission methods to intensive care unit: data analysis from 2006 to 2019 in the university hospital

作　　者：奚晶晶[1] 任会芳 张华[2] 赵志伶[1] 王铁华[1] 汪宗昱[1] 李雯 薄世宁[1] 么改琦[1] 赵扬玉[3] 王永清[3] 葛庆岗[1] Xi Jingjing;Ren Huifang;Zhang Hua;Zhao Zhiling;Wang Tiehua;Wang Zongyu;Li Wen;Bo Shining;Yao Gaiqi;Zhao Yangyu;Wang Yongqing;Ge Qinggang(Department of Intensive Care Unit,Peking University Third Hospital,Beijing 100191,China;Clinical Epidemiology Research Center,Peking University Third Hospital,Beijing 100191,China;Department of Obstetric and Gynecology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院危重医学科,北京100191 [2]北京大学第三医院临床流行病研究中心,北京100191 [3]北京大学第三医院产科,北京100191

出　　处：《中华危重病急救医学》2021年第10期1249-1254,共6页Chinese Critical Care Medicine

基　　金：国家重点研发计划项目(2016YFC1000208)。

摘　　要：目的比较不同重症监护病房(ICU)入院方式危重孕产妇的临床特征,以期更有效、合理利用ICU资源。方法采用回顾性研究方法,分析北京大学第三医院ICU 2006年1月至2019年7月救治的危重孕产妇的临床资料,根据ICU入院方式分为急诊入院组(因病情危重入产科病房当天或次日转入ICU)和计划入院组(入产科病房2 d后转入ICU)。收集危重孕产妇的发病情况、转入病因、病情严重程度、主要治疗措施、病死率等临床特征及医疗费用,并进行两组间的比较分析。结果近14年中,ICU共收治危重孕产妇576例,占同期产科住院患者的0.8%(576/71790),占同期ICU住院患者的4.6%(576/12412);7例孕产妇死亡,占ICU危重孕产妇的1.2%,孕产妇总体病死率为10/10万。576例危重孕产妇中,急诊入院327例(占56.8%),计划入院249例(占43.2%)。与计划入院组比较,急诊入院组孕产妇择期剖宫产比例更低(17.7%比94.0%,P<0.01),急诊剖宫产比例更高(65.1%比2.4%,P<0.01),急性生理学与慢性健康状况评分(APACHEⅡ、APACHEⅢ)、简化急性生理学评分Ⅱ(SAPSⅡ)和Marshall评分亦明显升高〔APACHEⅡ评分(分):6.0(4.0,9.8)比4.0(3.0,7.0),APACHEⅢ评分(分):14.0(11.0,20.3)比12.0(9.0,16.0),SAPSⅡ评分(分):8(0,12)比3(0,8),Marshall评分(分):2(1,4)比1(1,3),均P<0.01〕,且ICU住院时间明显延长〔d:2(1,5)比2(1,3),P<0.01〕,总住院时间明显缩短〔d:9(7,13)比13(10,18),P<0.01〕。急诊入院组和计划入院组孕产妇均以产科因素转入为主,分别为60.9%(199/327)和70.3%(175/249);其中产后出血占比最高〔分别为35.2%(115/327)和57.0%(142/249)〕,先兆子痫/子痫次之〔分别为7.0%(23/327)和7.6%(19/249)〕;19例产褥感染患者中仅有7例为计划入院;21例妊娠期急性脂肪肝(AFLP)患者均为急诊入院。在急诊入院和计划入院患者中,分别有73例(22.3%)和42例(16.9%)需要机械通气(机械通气时间>24 h),99例(30.3%)和35例(14.1%)应用了血管活性药物,67Objective To compare the clinical characteristics of critically ill pregnant women admitted to the intensive care unit(ICU)with different admission methods,in order to make more effective and rational use of ICU resources.Methods A retrospective study was conducted.The clinical data of critically ill pregnant women admitted to ICU of Peking University Third Hospital from January 2006 to July 2019 were analyzed.According to the admission mode to ICU,the pregnant women were divided into emergency admission group(transferred to ICU on the same day or the next day due to critical illness)and planned admission group(transferred to ICU 2 days after admitting in obstetric ward).The clinical characteristics of ICU critical pregnant women,such as the incidence,causes of admission,severity of the disease,main treatment measures,mortality,and medical expenses were collected,and a comparative analysis between the two groups was performed.Results During the nearly 14 years,a total of 576 critical pregnant women in ICU were enrolled,accounting for 0.8%(576/71790)of the total number of obstetric inpatients and 4.6%(576/12412)of the total number of ICU inpatients.Seven maternal deaths accounted for 1.2%of all critically pregnant women transferred to ICU,and the overall mortality of pregnant women was 10/100 thousand.Of the 576 critically pregnant women,there were 327 patients(56.8%)in the emergency admission group and 249 patients(43.2%)in the planned admission group.Compared with the planned admission group,the proportion of elective cesarean section in the emergency admission group was significantly lower(17.7%vs.94.0%,P<0.01),and the proportion of emergency cesarean section was significantly higher(65.1%vs.2.4%,P<0.01),the acute physiology and chronic health evaluation(APACHEⅡ,APACHEⅢ)scores,simplified acute physiology scoreⅡ(SAPSⅡ)and Marshall score were significantly higher[APACHEⅡscore:6.0(4.0,9.8)vs.4.0(3.0,7.0),APACHEⅢscore:14.0(11.0,20.3)vs.12.0(9.0,16.0),SAPSⅡscore:8(0,12)vs.3(0,8),Marshall score:2(1,4)vs

关 键 词：重症监护病房 危重孕产妇 急诊入院 计划入院 

分 类 号：R714[医药卫生—妇产科学]