机械通气在危重症孕产妇中的应用

Role of mechanical ventilation in critically ill obstetric patients

目的分析危重症孕产妇行机械通气治疗的特点和围产结局。方法对广州医科大学附属第三医院妇产科重症孕产妇救治中心ICU 1999年1月至2008年1月收治的114例需机械通气治疗的危重症孕产妇临床相关资料进行回顾性分析,包括一般资料、行机械通气治疗的病种和指征、未分娩者行机械通气情况、呼吸机模式的选择与通气指标以及脱机情况等。结果 114例需机械通气治疗的危重症孕产妇中,未分娩者10例,其中8例合并有基础疾病,6例胎儿在行机械通气治疗前已发生胎死宫内。需机械通气的产科病因主要为重度子痫前期或子痫及相关并发症(34.21%)、失血性休克(27.19%),非产科病因主要为妊娠合并风湿性心脏病并心力衰竭(6.14%)和妊娠合并重症肝炎(6.14%)。危重症孕产妇行机械通气治疗的主要指征是低氧血症(62.28%)和低通气量(37.72%)。孕产妇死亡26例,占22.81%。结论危重症孕产妇机械通气的产科病因主要为重度子痫前期或子痫及相关并发症和失血性休克等;容量控制下的同步间歇指令通气(SIMV)+压力支持通气(PSV)+呼气未正压(PEEP)模式是机械通气呼吸机的常用模式,可减少孕产妇肺水肿的发生;在危重症孕产妇救治过程中机械通气的特点值得产科及ICU科医生重视。

Objective To analyze the characteristics and outcomes of critically ill obstetric patients who required mechanical ventilation. Methods The data of critically in obstetric patients, who required mechanical ventilation at obstetric intensive care unit in a tertiary hospital from January 1999 to January 2008, were retrospectively collected. The data included general information, the causes and indication of ventilation, the clinical information of pregnancy women being supported with mechanical ventilation, ventilation mode, ventilation index, the number of times of removal of mechanical assistance, and so on. Results There were 114 women included in the present study. Ten women were un-delivery when requiring mechanical ventilation, eight of whom suffered from co-existed underlying disease, and six of whom result in stillbirth. The major obstetric diseases requiring mechanical ventilation were preeclampsia or eclampsia with severe complications （34.21%）, and hemorrhagic shock （27.19%） ; while the major non-obstetric underlying disease were rheumatic heart disease with heart failure （6. 14% ） and severe hepatitis （6. 14% ）. The indications for mechanical ventilation were hypoxemia （62. 28% ） and hypoventilation （37.72%）. Twenty-six patients were died and the mortality rate was 22.81%. Condusions The major obstetric diseases requiring mechanical ventilation were preeclampsia or eclampsiawith severe complications and hemorrhagic shock in critically ill obstetric patients. The best mode of mechanical ventilation was SIMV ＋ PSV ＋ PEEP, which can reduce the pulmonary edema of the patients. The obstetricians and intensive care specialists should pay attention to the mechanical ventilation characteristic of the critically ill obstetric patients.