CAJ | 학술논문

目的探讨入住重症监护病房(intensive care unit,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Wilcoxon秩和检验和x2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％(476/27 836),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).产科原因组入住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=0.000]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),x2=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) (x2=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),x2=9.118,P=0.003],子宫切除率[15.33％(40/261)与0.93％(2/215),x2=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),x2=10.781,P=0.001]. 结论入住ICU的危重孕产妇疾病谱多样,病死率高.产科原因危重症者应适时终止妊娠,妊娠前有基础疾病者应在病情控制后再妊娠,且妊娠期应加强监测.
목적 탐토입주중증감호병방(intensive care unit,ICU)적위중잉산부적림상특정급기위산결국. 방법 대2009년6월지2014년6월재엄주의과대학부속제삼의원주원병분면,차입주ICU적476례위중잉산부적림상자료진행회고성분석.근거위중잉산부입주ICU적질병보분위산과원인조화비산과원인조,비교조간질병구성급위산결국적차이.채용비삼수Wilcoxon질화검험화x2검험진행통계학분석.결과 입주ICU적위중잉산부공476례,점5년총주원분면량적1.71％(476/27 836),평균년령위(29.04±5.77)세,평균잉주위(32.00±5.63)주.산과원인조점54.83％(261/476),비산과원인조점45.17％(215/476).산과원인조입주ICU질병보전3위의차위임신기고혈압질병(35.29％,168/476)、산후출혈(11.97％,57/476)화임신기급성지방간(2.31％,11/476).비산과원인조전3위위임신합병급성중형간염(7.56％,36/476)、임신합병중증폐염(5.67％,27/476)화병렬제3위적임신합병선천성심장병(3.57％,17/476)여임신합병급성중증이선염(3.57％,17/476).산과원인조잉산부년령[(30.02±5.62)여(27.85±5.75)세,Z=4.198,P=0.000]화미규률산전검사적비례고우비산과원인조[75.86％(198/261)여61.40％(132/215),x2=11.603,P=0.001].산과원인조잉산부이급진부궁산종지임신상견(56.71％,148/261),이비산과원인조이병정은정후택기부궁산종지임신다견(45.58％,98/215) (x2=21.990,P=0.000).산과원인조병사솔저우비산과원인조[1.53％ (4/261)여6.98％(15/215),x2=9.118,P=0.003],자궁절제솔[15.33％(40/261)여0.93％(2/215),x2=30.367,P=0.000]화신생인질식솔고우비산과원인조[36.17％(102/282)여22.62％(50/221),x2=10.781,P=0.001]. 결론 입주ICU적위중잉산부질병보다양,병사솔고.산과원인위중증자응괄시종지임신,임신전유기출질병자응재병정공제후재임신,차임신기응가강감측.
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.Results Totally, 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), x2=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) (x2=21.990, P=0.000).The mortality rate in Group 1 was lower [1.53％(4/261) vs 6.98％(15/215), x2=9.118], but the rates of hysterectomy [15.33％(40/261) vs 0.93％(2/215), x2=30.367, P=0.000] and neonatal asphyxia were higher than in Group 2 [36.17％(102/282) vs 22.62％(50/221), x2=10.781, P=0.001].Conclusions The reasons for ICU admission of critically ill obstetric patients are diverse and patients have a high mortality rate.Pregnant women with obstetric related diseases should be terminated timely and those with non-obstetric related diseases should be conceived after disease control and closely monitored during pregnancy.