围生期心脏骤停孕产妇特点及心肺复苏术预后分析

Characteristics of pregnant women suffering perinatal cardiac arrest and their prognosis after cardiopulmonary resuscitation

目的研究围生期心脏骤停孕产妇的特点和预后情况。方法选取杭州市余杭区第一人民医院2008年1月至2016年6月收治的围生期心脏骤停孕产妇20例,分析心脏骤停孕产妇的临床资料,包括年龄、性别、孕周、产次及分娩方式,同时录入手术指征、病因及心脏复苏至分娩时间。结果 20例孕产妇中5例采取阴式分娩(20%),13例采取剖宫产(65%),2例采取引产(10%);7例剖腹产手术指征不明确(35%),9例羊水栓塞(45%),5例子痫(20%),3例产科出血(15%)。产科首次抢救9例发生心脏骤停的孕产妇,其中存活3例,死亡6例;产科和ICU联合首次抢救11例发生心脏骤停的孕产妇,其中存活10例,死亡1例,不同抢救方式存活率差异有统计学意义(χ~2=7.213,P=0.007)。7例患者在分娩前发生呼吸心脏骤停,5例死亡,2例存活;13例分娩后发生呼吸心脏骤停,2例死亡,11例存活。13例存活患者中7例伴随严重脑损伤后遗症。结论孕产妇发生心脏骤停引起死亡率较高,产科联合ICU能有效提高抢救成功率,提高辨识危险因素的准确度可有效降低死亡率。

Objective To study the characteristics of pregnant women with perinatal cardiac arrest and their prognosis. Methods Twenty cases of perinatal cardiac arrest admitted in Yuhang District First People＇s Hospital from January 2008 to June 2016 were selected. Clinical data of pregnant women with cardiac arrest was analyzed,including age,sex,gestational age,parity and deliverymode. Operation indication,causes of cardiac arrest and time from cardiac resuscitation to delivery were inputted at the same time. Results Among 20 pregnant women,5 cases（ 20%） adopted vaginal delivery,13 cases（ 65%） delivered by cesarean section,and 2 cases（ 10%） received induced labor. Indications for cesarean section in 7 cases（ 35%） were not clear,amniotic fluid embolism happened in 9 cases（ 45%）,eclampsia occurred in 5 cases（ 20%）,and obstetric hemorrhage occurred in 3 cases（ 15%）. Among 9 cases of maternal cardiac arrest receiving emergency treatment in obstetrics department,3 cases survived and 6 died. Among 11 cases of maternal cardiac arrest receiving combined emergency treatment of obstetrics department and ICU,10 cases survived,and 1 case died. There was significant difference in survival rate of different rescue methods（ χ^2= 7. 213,P = 0. 007）. In 7 patients suffering respiratory and cardiac arrest before delivery,5 cases died and 2 cases survived. In 13 cases with respiratory and cardiac arrest after delivery,2 cases died and 11 cases survivied. Among13 patients who survived,7 patients were with severe brain injury. Conclusion Maternal cardiac arrest causes high mortality. Combination of obstetrics department and ICU in emergency treatment can effectively improve the success rate of rescue. Improvement of accuracy in identifying risk factors can reduce mortality effectively.