360例危重孕产妇ICU救治分析  

Analysis of treatment for 360 critically ill pregnant and parturient women in intensive care unit

作　　者：岳锦熙[1] 黄青青[1] 任宗芳 杨阳[1] 段玉珊 陈艳[2] 万林骏[1] Yue Jinxi;Huang Qingqing;Ren Zongfang;Yang Yang;Duan Yushan;Chen Yan;Wan Linjun(Department of Critical Care Medicine,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,Yunnan,China;Department of Obstetrics,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,Yunnan,China)

机构地区：[1]昆明医科大学第二附属医院重症医学科,云南昆明650101 [2]昆明医科大学第二附属医院产科,云南昆明650101

出　　处：《中华危重病急救医学》2022年第8期853-857,共5页Chinese Critical Care Medicine

基　　金：云南省科技厅科技计划项目 (202001AY070001-063)。

摘　　要：目的分析重症医学科收治的危重孕产妇临床特点及其转归,为重症产科亚专业建设提供临床经验。方法收集2011年1月至2019年12月昆明医科大学第二附属医院重症医学科收治的危重孕产妇的临床资料。总结孕产妇转入重症监护病房(ICU)的主要原因、孕产妇死亡原因、器官支持措施等。结果研究期间,本院产科共收治39567例孕产妇,转入ICU 360例,平均ICU转入率0.91%;2016年起,产科收治人数、转入ICU人数及ICU转入率均明显增加。ICU收治孕产妇平均年龄(30.9±5.7)岁,平均急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)为7(4,10)分,平均ICU住院时间为1(1,2)d;平均呼吸机使用时间为9.0(3.0,17.5)h。ICU孕产妇最主要的分娩方式为剖宫产(占84.72%);48例(占13.33%)行子宫切除,其中42例(占87.5%)因产后出血行子宫切除。孕产妇转入ICU的前3位病因为产后大出血〔36.94%(133/360)〕、妊娠期高血压疾病〔21.67%(78/360)〕、妊娠合并心脏病〔15.00%(54/360)〕。因产后大出血转入ICU的产妇的首位出血原因为胎盘异常〔63.98%(103/161)〕,其次为宫缩乏力〔28.57%(46/161)〕;产后24 h平均失血量为(4019±2327)mL,因产后大出血而切除子宫的产妇逐年减少。研究期间共有2例产妇死亡,为间接产科死亡;3例自动转出(预计死亡),其中1例为间接产科死亡,2例为直接产科死亡;ICU孕产妇病死率为1.39%(5/360)。结论孕产妇转入ICU的主要原因为产后大出血和妊娠期高血压疾病,产后大出血的首要原因为胎盘因素;间接产科死亡超过直接产科死亡,主要是妊娠合并心脏病及重症肺炎导致的死亡;ICU已成为救治危重孕产妇的重要阵地以及降低孕产妇病死率的重要保障。Objective To analyze the clinical characteristics and outcomes of critically ill pregnant and parturient women in intensive care unit(ICU),and to provide clinical experience for the subspecialty construction of critical obstetrics.Methods The clinical data of critically ill pregnant and parturient women admitted to the department of critical care medicine,the Second Affiliated Hospital of Kunming Medical University from January 2011 to December 2019 were collected.The main reasons for maternal transfer to ICU,the causes of maternal death,and organ support measures,etc.were summarized.Results A total of 39567 critically ill pregnant and parturient women were admitted to the department of obstetrics in our hospital,and 360 were transferred to ICU,with an average ICU transfer rate of 0.91%.Since 2016,the number of obstetric admissions,the number of ICU transfers and the ICU transfer rate had increased significantly.The average age of severe maternals admitted to ICU was(30.9±5.7)years old.The average acute physiology and chronic health evaluationⅡ(APACHEⅡ)score was 7(4,10).The average length of ICU stay was 1(1,2)day.The average ventilator duration was 9.0(3.0,17.5)hours.The main delivery mode of pregnant women in ICU was cesarean section(84.72%).Forty-eight patients(13.33%)underwent hysterectomy,of which 42(87.5%)due to postpartum hemorrhage.The top 3 causes of ICU admission were severe postpartum hemorrhage[36.94%(133/360)],hypertensive disorders of pregnancy[21.67%(78/360)],pregnancy with cardiac disease[15.00%(54/360)].The leading cause of postpartum hemorrhage in women transferred to ICU was placental abnormality[63.98%(103/161)],followed by uterine atony[28.57%(46/161)].The average blood loss was(4019±2327)mL within 24 hours after delivery,and the number of women who underwent hysterectomy due to postpartum hemorrhage decreased year by year.During the study period,there were 2 maternal deaths,which were indirect obstetric deaths,3 cases were discharged against-advice(expected death),including 1 indirect

关 键 词：孕产妇 产后大出血 妊娠期高血压疾病 重症医学科 

分 类 号：R714.2[医药卫生—妇产科学]