孕产妇心脏骤停的临床研究

Clinical characteristics of maternal cardiac arrest

目的探讨孕产妇心脏骤停预后的影响因素,为抢救危重孕产妇(MNM)心脏骤停提供理论依据。方法通过分层随机整群抽样回顾性分析湖南省18家医院2012年1月1日-2013年12月31日入院的所有孕产妇,依据孕产妇心脏骤停后是否死亡分为孕产妇死亡MD组和MNM组,分析患者的年龄、孕次、产次、孕周、产前检查次数、分娩方式、合并慢性基础疾病、目击者早期识别、是否入住重症加强护理病房(ICU)及早期高级生命支持等,采用SPSS 18.0统计软件进行数据分析。结果该研究共收集129 259例孕产妇,发生心脏骤停21例,孕产妇心脏骤停的发病率为1∶6 155次分娩,发生心脏骤停的孕产妇中死亡16例,孕产妇发生心脏骤停后的病死率为76.19%(16/21)。21例心脏骤停患者行初级心肺复苏,11例成功,10例失败。MD组与MNM组在产前检查≥5次,目击者早期识别,入住ICU和正确及时的高级生命支持方面比较,差异均有统计学意义(P=0.006、0.011、0.025和0.035)。两组孕产妇的年龄、孕次、产次、孕周、文化程度以及剖宫产次数等比较,差异均无统计学意义。孕周>20周而胎儿未娩出发生的5例心脏骤停患者中,3例行围死亡期剖宫产术(PMCS)的孕妇均存活,未行PMCS的2例孕妇死亡。结论早期识别并予以就地心肺复苏及正确、及时的高级生命支持是心肺复苏成功的关键。孕周>20周的孕妇发生心脏骤停时,建议尽快实施PMCS。分娩量大的医疗保健机构应建立ICU,并加强对心脏骤停高危对象的识别培训,有利于预防和降低孕产妇心脏骤停的发生。

[Objective] To analyze the clinical characteristics of maternal cardiac arrest and prognostic factors so as to provide scientific evidence for maternal cardiac arrest resuscitation. [Methods] The data of all cases of maternal cardiac arrest from January 1, 2012 to December 31, 2013 in the selected hospitals were retrospectively studied by stratified cluster sampling. Maternal cardiac arrests were divided into maternal death （MD） and maternal near miss （MNM）. The patient＇s age, gravidity, parity, gestational age, number of pre- natal care, delivery method, combined chronic underlying diseases, early identification by eyewitness, intensive care unit （ICU） availability, early advanced life support, etc. were collected. The data were analyzed via SPSS 18.0. [Results] A total of 21 maternal cardiac arrests were collected from the 129,259 deliveries during the study period. The incidence of maternal cardiac arrest rate was 1 ： 6,155 births. Case fatality rate of maternal cardiac arrest was 76.19% （16/21）. All the 21 cases of cardiac arrest received primary cardiopulmonary resus- citation （CPR）, of which 11 cases were successful, 10 cases failed. There were statistically significant dif- ferences in prenatal care more than five times （P=0.006）, early identification by eyewitness （P=0.011）, check- in in ICU （P = 0.025） and primary advanced life support CPR （P= 0.035） between MD and MNM groups. Among the 5 cases of cardiac arrest with gestational age greater than 20 weeks, 3 pregnant women receiving perimortem caesarean section （PMCS） were alive, the 2 cases that did not undergo PMCS were dead. [ Conclusions] Early recognition and proper in-place in-time CPR and advanced life support are the keys to the success of cardiopulmonary resuscitation. PMCS should be done as soon as possible for pregnant women with cardiac arrest after 20 weeks of gestational age. ICU should be set up in the hospitals with large amount of delivery, the identification training of high-risk target should be enhanced so as to prevent and reduce the occurrence of maternal cardiac arrest.