危重孕产妇抢救管理临床模式研究

Study on the clinical mode of critical pregnant women rescue and management

目的:对危重症孕产妇抢救通道、流程及实施过程进行分析优化、评估抢救效果,探讨及提出危重孕产妇抢救临床模式。方法:2009年10月～2010年9月上海市第六人民医院危重孕产妇抢救中心共救治危重孕产妇96例,绝大多数患者通过绿色通道直接进入抢救中心,采用组织多学科会诊、团队合作抢救,抢救中各级人员责任分明的临床模式,并分析其救治效果。结果:直接产科原因抢救55例,非产科原因抢救41例。抢救病因顺位前三位依次为子痫前期重度(34例,35.4%),脑部病变(7例,7.3%),重症急性胰腺炎(6例,6.3%)。96例中极危重孕产妇30例,子痫前期重度并发重要脏器功能障碍者10例,其中心衰6例:产科出血、出血性休克4例,子宫切除2例;非产科病因所致极危重孕产妇14例,占近1/2,重症急性胰腺炎发病率明显增高。抢救成功率100%,预后不良3例(恶性肿瘤2例),围产儿死亡6例,无孕产妇死亡。结论:危重孕产妇抢救新临床模式不仅有利于抢救通道及流程更通畅,明显提高了抢救成功率,而且有助于相关专业人员抢救知识及技能的提高。

Objective：To analyze and optimize the rescue passage,process and implementation of critical pregnant women,evaluate the effect of rescue,explore and put forward the clinical mode of critical pregnant women rescue. Methods：96 critical pregnant women were rescued in emergency center of the hospital from October 2009 to September 2010,the most of the critical pregnant women entered into emergency center directly,received the clinical mode of multi-department consultation,team rescue cooperatively and clear responsibility of medical workers at all levels in rescue;the effect of rescue was analyzed. Results：The numbers of rescued critical pregnant women with direct obstetrical causes and indirect obstetrical causes were 55 and 41.The top three rescue causes were severe preeclampsia（34 cases,35.4%）,brain lesions（7 cases,7.3%） and severe acute pancreatitis（6 cases,6.3%）.Among 96 critical pregnant women,30 pregnant women were very critical,10 pregnant women were found with severe preeclampsia combined with important organ dysfunction,including 6 pregnant women with heart failure;4 pregnant women were found with obstetrical hemorrhage and hemorrhagic shock,including 2 pregnant women undergoing hysterectomy;14 very critical pregnant women were induced by non-obstetrical causes,accounting for nearly 1/2,the incidence of severe acute pancreatitis increased significantly.The success rate of rescue was 100%,3 pregnant women were found with poor prognosis,including 2 pregnant women with malignant tumors;6 perinatal infants died,no maternal death occurred. Conclusion：The new clinical mode of critical pregnant women rescue is not only helpful to rescue passage and smooth process,increasing the success rate of rescue,but also helpful to improve the rescue knowledge and skills of related professionals.