342例重症产科患者年龄分布及发病因素的回顾性分析

Retrospective analysis of the age and disease distribution in 342 severe obstetric patients

目的探讨山东省聊城市人民医院(我院)重症医学科(ICU)收治重症产科患者的临床特点,分析年龄分布及发病因素,以指导治疗,降低病死率.方法收集2013年1月至2017年1月入住我院ICU的重症产科患者的临床资料,分析其年龄、急性生理与慢性健康状况(APACHEⅡ)评分、各疾病构成、住院时间和病死率.结果342例重症产科患者中发病前3位分别为妊娠期高血压疾病(116例,占33.9%)、产后出血(105例,占30.7%)及脏器功能损害(95例,占27.8%).不同年龄段病因趋势不同,≤20岁组以妊娠期高血压疾病常见,21例患者中发生12例.21~30岁组以妊娠期高血压、脏器功能损害居多,172例患者中分别发生56、60例;31~40岁组以产后出血、妊娠期高血压疾病为主,128例患者中分别发生56、42例;>40岁组21例患者中产后出血、妊娠期高血压和脏器功能损害发生例数相当,分别为7、6、6例.不同病因下APACHEⅡ评分不同,其中脏器功能损害组评分最高[(15.56±6.14)分],妊娠期高血压疾病组最低[(11.46±3.01)分],不同病因组之间APACHEⅡ评分差异具有统计学意义(P<0.05).病因不同所致ICU住院时间不同,其中脏器功能损害组时间最长[(8.69±9.21)d],妊娠期高血压疾病组最低[(4.38±1.67)d],不同病因组之间ICU住院时间差异具有统计学意义(P<0.05).产后出血及妊娠期高血压疾病组死亡人数为0例,脏器功能损害组死亡5例,其他类组死亡人数为1例.结论重症产科常见原因为妊娠期高血压疾病、产后出血,不同年龄段表现不一,应加强孕期检查及干预,预防并发症,降低病死率.

Objective To investigate the clinical characteristics of severe obstetric patients in the intensive medical care (ICU) in our hospital with the analysis of the age and disease distribution to guide the treatment and reduce the mortality rate. Methods The clinical data of severe obstetric patients who admitted in our ICU from January 2013 to January 2017 were collected. We analyzed the age, APACHE Ⅱ score, disease composition, the length of ICU stay and mortality. Results 342 severe obstetric patients were included and the most important three diseases were gestational hypertension (116, 33.9%), postpartum hemorrhage (105, 30.7%) and organ dysfunction failure (95, 27.8%). Different disease distribution was found in different age population. Hypertensive disorders of pregnancy was most common in patients with age less than 20 years old (12/21) while gestational hypertension (56/172) and organ dysfunction failure (60/172) was most common in patients with age between 20 and 30 years old. Of 128 patients with age of 31 to 40 years old, 56 were postpartum hemorrhage and 60 developed to gestational hypertension, which were major diseases. The uniform diseases distribution was found in patients with age old than 40 years old. There were 7 postpartum hemorrhage, 6 gestational hypertension and 6 organ dysfunction patients, respectively among 21 patients. Different APACHE Ⅱ score, length of ICU stay and mortality were found in different diseases population. The death of postpartum hemorrhage, gestational hypertension, organ dysfunction failure and others was 0, 0, 5, 1 cases, respectively. Conclusion Gestational hypertension, postpartum hemorrhage and organ dysfunction are most common in severe obstetric patients, with different distribution in different age population. Our results indicates that strengthen assessment and early intervention can prevent complications and reduce mortality.