上海市危重孕产妇感染性疾病74例资料分析

Analysis of infectious diseases in 74 cases of maternal near - miss women in Shanghai

目的分析危重孕产妇中感染性疾病患者的诊治经过及相关资料，总结经验与教训，探讨如何提高危重孕产妇感染性疾病的救治能力。方法采用描述性分析方法，对上海市2008-01-2010—06期间86家接产医院上报的691例危重孕产妇中74例感染性疾病患者的相关资料进行分析。结果①74例危重孕产妇感染性疾病患者，告病危34例（45．9％），病重40例（54．1％），经抢救存活68例，抢救成功率91．9％。②74例中前5位疾病顺位分别是重症肺炎（40．5％）、产褥感染（12．2％）、急性重症胰腺炎（10．8％）、感染性休克（9．5％）、重症肝炎（8．1％）。③抢救医院以二三级综合性医院为主，49例（66．2％）在三级综合医院，19例（25．7％）在二级综合医院；有16例转诊，最终共61例（82．4％）在5家危重孕产妇会诊抢救中心救治。④74例中外地户籍孕产妇56例（75．7％），上海户籍18例（24．3％），两组仅平均年龄比较差异有统计学意义（P〈0．05），孕次、产次、产前检查次数比较差异均无统计学意义（P〉0．05）。结论①综合医院，尤其是5家危重孕产妇会诊抢救中心为龙头的危重孕产妇救治网络发挥了重大作用。②近年上海市危重孕产妇中妊娠合并症，尤其感染性疾病所占比例逐渐增大，需要ICU、感染科、呼吸科等多学科共同参与救治。

Objective To analyze the process of diagnosis and treatment as well as basic data of infectious diseases among maternal near - miss women, and to summarize the experience and lessons in order to improve the treating ability. Methods Descriptive analysis of 74 eases of infectious diseases among 691 cases of maternal near - miss women from Jan. 2008 to June 2010. The data were gathered from all the 86 delivery hospitals in Shanghai. Results （1）Among the 74 cases, 34 cases were near miss （45.9%） ,40 cases were severe（ 54.1% ）. 68 women survived, the successful rate was 91.9%. （2）The diseases stood on the top 5 rank of incidence list followed by severe pneumonia （ 40. 5% ）, puerperal infection（ 12.2% ） , acute severe pancreatitis （ 10.8% ） , septic shock（9.5% ） and severe hepatitis（8.1% ）. （3）Most women were treated in comprehensive hospital, 49 cases（66.2% ）in third class, 19 cases（25.7% ）in secondary class. Including the 16 transferred cases, altogether 61 women （ 82.4% ） were treated in 5 municipal salvage centers of maternal near - miss. （4）Among the 74 cases, 56 was foreign （75.7%）, 18 was native（24.3% ）. Only the difference of age had statistical differences between the two groups. There were no differences in the times of pregnancy, delivery, pre - natal examination. Conclusion （1）The salvage network leaded by the comprehensive hospitals, especially the 5 municipal salvage centers of maternal near - miss, plays an important role in treating infectious diseases among maternal near- miss women. （2）Recently, more and more maternal near - miss women suffered from internal medicine or surgery complications, especially infectious diseases. It is urgent to combine several disciplines, such as intensive care unit （ICU） , infection or respiration disciplines ete, to work together so as to improve survival rate.