孕产期脓毒症临床特点分析

Analysis of characteristics in sepsis during pregnancy and puerperium

目的总结孕产期脓毒症的临床特点。方法回顾性分析2016年1月至2019年12月首都医科大学附属北京妇产医院分娩的41例产妇的临床资料。发生孕产期脓毒症12例,即妊娠期和产褥期感染继发器官功能损害[序贯器官衰竭评分(sequential organ failure assessment, SOFA)≥2分];发生血流感染29例,即妊娠期和产褥期感染有感染临床表现和血培养阳性,但无器官损害。比较两组的一般情况、高危因素、感染诱因、感染发生时间及来源、感染病原体、炎症指标以及治疗方案,总结孕产期脓毒症的临床特点。结果与血流感染组相比,脓毒症组中≥2次宫腔操作者明显增多(OR=17.33, P=0.001);合并产后出血的病例数明显增加(OR=5.25, P=0.025)。两组WBC、CRP值比较,差异无统计学意义(P>0.05),脓毒症组的中性粒细胞数(P=0.010)和PCT值明显高于血流感染组(P=0.001)。脓毒症组中有3例需要介入治疗控制产前和产后出血,有3例需要外科手术将感染灶切除控制感染,血流感染组无上述处理,差异均有统计学意义(P=0.021)。此外,两组血培养为耐药病原体的比率的差异无统计学意义(P=0.098),但脓毒症组需联合使用抗菌药物(含酶抑制剂+氨基糖苷类或喹诺酮类/碳青霉烯类+氨基糖苷类或喹诺酮类)控制感染者5例,而血流感染组无需联合用药(P=0.001)。脓毒症组抗菌药物使用≥10 d者亦明显增加(P=0.000)。结论对于妊娠期和产褥期多次行宫腔操作、介入治疗、产后出血者,尤其是临床症状隐匿、实验室指标提示有感染可能时,更要警惕脓毒症。一旦发生脓毒症,需尽早联合应用敏感抗菌药物控制感染,必要时采用外科手术去除感染灶以改善预后。

Objective To summarize the clinical characteristics of sepsis during pregnancy and the puerperium. Methods A retrospective analysis of 41 maternal cases was carried on from January 2016 to December 2019 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University. There were 12 patients in the sepsis group(SOFA ≥ 2 points) and 29 patients in the blood stream infections(the control group). The risk factors, infection inducement, time and source of infection,pathogen of infection, inflammatory response index and treatment plan between the two groups were compared. Results Compared with the control group, the number of cases with multiple intrauterine operation(OR = 17.33, P = 0.001), postpartum hemorrhage(OR = 5.25, P = 0.025) increased significantly in the sepsis group. Although there was no significant difference in WBC, CRP between the two groups, the count of neutrophil and PCT in the sepsis group were significantly higher than those in the control group(P = 0.010, P = 0.001). In the sepsis group, three patients needed an interventional treatment and three patients needed surgical removal of the infection site to control the infection, there were significant differences between the two groups(P = 0.021). Although there was no difference of the ratio of drug-resistant pathogens between the two groups(P = 0.672), five cases in the sepsis group needed combined use of antibiotics to control the infection, and the control group didn’t need(P = 0.001). Antibiotic use day≥ 10 d also increased significantly in the sepsis group(P = 0.000).Conclusions During pregnancy and puerperium, the patients with multiple intrauterine operation, interventional treatment, postpartum hemorrhage, especially clinical symptoms are insidious, while laboratory indicators suggest the possibility of infection,should be paid more alert to sepsis. In the event of sepsis during pregnancy and the puerperium,the combination of sensitive antibiotics should be used to control the infection, and surgical removal of the infection site would be needed to improve the prognosis.