167例ICU危重症孕产妇救治分析

Analysis of treatment with 167 critically ill pregnant women in intensive care unit

目的 分析危重症孕产妇的致病因素、临床特点及重症医学科（ICU）治疗措施,为提高救治成功率提供经验.方法 回顾分析2013年1月至2017年12月贵州医科大学附属医院ICU收治的167例危重症孕产妇临床资料,收集患者病种分布、产后大出血患者病因及救治情况、以及死亡结果;按照病种将患者分为产科并发症组、妊娠合并基础疾病组及伴其他器官合并症组,分析各组的救治情况.结果 167例危重症孕产妇中,产科并发症118例（占70.6%）,妊娠合并基础疾病26例（占15.6%）,伴其他器官合并症23例（占13.8%）.167例危重症孕产妇共死亡9例,病死率为5.4%.产后大出血为主要产科并发症（占35.3%）,59例产后大出血患者经积极止血治疗及合理输血后48 h凝血功能显著改善〔与入ICU比较,凝血酶原时间（PT,s）：14.49±4.66比23.39±8.11,活化部分凝血活酶时间（APTT,s）：52.94±36.36比87.35±74.69,纤维蛋白原（Fib,g/L）：2.91±1.03比1.03±0.65,血小板计数（PLT,×109/L）：94.85±30.09比43.15±24.07,均P＜0.01〕.与妊娠合并基础疾病组及伴其他器官合并症组比较,产科并发症组急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）更低（分：10.41±4.85比16.46±13.87、16.90±8.82,均P＜0.05）,ICU住院时间更短（h ：57.83± 34.67比79.64±36.01、278.30±83.72,均P＜0.05）;与伴其他器官合并症组比较,产科并发症组机械通气时间更短〔h ：14（6,38）比43（12,396）,P＜0.05〕,病死率更低（0.8%比13.0%,P＜0.05）.结论 应密切观察ICU危重症孕产妇的病情变化,进行必要的血流动力学治疗、呼吸支持、器官功能支持等,可提高抢救成功率并改善患者预后.

Objective To analyze the pathogenic factors, clinical features and treatment measures of critically ill pregnant women so as to provide experience for improving the success rate of treatment. Methods The clinical data of 167 cases of critically ill pregnant women who admitted to intensive care unit （ICU） of the Affiliated Hospital of Guizhou Medical University from January 2013 to December 2017 were collected, and the disease distribution of patients, the causes of postpartum hemorrhage, the treatment situation and the results. Patients were divided into obstetrical complications group, pregnancy complicated with basic diseases group and other complicated diseases group according to disease types, and the treatment status of each group was analyzed. Results Among 167 critically ill pregnant women, 118 cases （70.6%） were in the obstetric complications group, 26 cases （15.6%） were in the pregnancy complicated with basic diseases group, and 23 cases （13.8%） were in the other complicated diseases group. Nine cases died in 167 critically ill pregnant women, with a mortality rate of 5.4%. Postpartum hemorrhage was the major obstetric complication （35.3%）, and the coagulation function of 59 patients with postpartum hemorrhage was significantly improved 48 hours after active hemostasis and reasonable blood transfusion [compared to entering the ICU, prothrombin time （PT, s）： 14.49±4.66 vs. 23.39±8.11, activated partial thromboplastin time （APTT, s）： 52.94±36.36 vs. 87.35±74.69, fibrinogen （Fib, g/L）： 2.91±1.03 vs. 1.03±0.65, platelet count （PLT, ×109/L）： 94.85±30.09 vs. 43.15±24.07, all P 〈 0.01]. Compared with pregnancy complicated basic diseases group and other complicated diseases group, the acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） scores was reduced significantly in obstetrical complications group （10.41±4.85 vs. 16.46±13.87, 16.90±8.82, both P 〈 0.05）, the length of ICU stay was significantly reduced （hours： 57.83±34.67 vs. 79.64±36.01, 278.30±83.72, both P 〈 0.05）. Compared with other complicated diseases group, the mechanical ventilation time [hours ：14 （6, 38） vs. 43 （12, 396）] and mortality （0.8% vs. 13.0%） were significantly decreased in obstetrical complications group （both P 〈 0.05）. Conclusions Observe the changes of the condition closely, necessary hemodynamic treatment, respiratory support, and organ function support with critically ill pregnant women can improve the rescue success rate and prognosis.