136例危重孕产妇临床特征及其入住ICU的影响因素

Clinical characteristics of 136 maternal near miss and the influence factors of admission to ICU

目的了解危重孕产妇的流行病学特点,探讨其入住ICU的影响因素。方法回顾性分析东南大学附属中大医院2016年1月至2019年12月136例危重孕产妇的临床资料,以是否入住ICU分为未入住ICU组(60例)和入住ICU组(76例)。收集包括年龄、学历、居住地、外院转诊、是否经产妇、是否规律产检、孕前体质量指数(BMI)、瘢痕子宫、分娩方式、分娩孕龄、24 h产后出血量、首要致病因素及主要致病因素等临床特征,并对其进行单因素及多因素Logistic回归分析。结果危重孕产妇前3位首要致病因素为产后出血(39.0%),妊娠期高血压疾病(19.1%)及妊娠合并心脏病(8.8%)。2组患者年龄、学历、居住地、是否经产妇、是否规律产检、瘢痕子宫、分娩孕龄、24 h产后出血量比较,差异均无统计学意义(P>0.05)。2组患者外院转诊、孕前BMI、分娩方式、主要致病因素比较,差异均有统计学意义(χ^(2)=4.802,P=0.028;P<0.001;χ^(2)=5.913,P=0.015;χ^(2)=15.074,P<0.001)。多因素回归分析显示孕前BMI(≥25 kg/m^(2))、主要致病因素(妊娠合并症)是危重孕产妇入住ICU的独立危险因素(OR=31.816,95%CI:1.767~1339.337,P=0.036;OR=31.894,95%CI:5.029~720.700,P=0.003)。结论危重孕产妇的首要致病因素仍为产后出血、妊娠期高血压疾病及妊娠合并心脏病,孕前BMI≥25 kg/m^(2)及具有妊娠合并症是危重孕产妇进入ICU的危险因素。

Objective To investigate the epidemiological characteristics of maternal near miss,and to explore the influencing factors of admission to ICU.Methods The clinical data of 136 maternal near miss from January 2016 to December 2019 in the Zhongda Hospital affiliated to Southeast University were retrospectively analyzed.These patients were divided into no-ICU group(60 cases)and ICU group(76 cases).Clinical data including age,education,place of residence,referral,pluriparity,prenatal visit,pre-pregnancy BMI,scarred uterus,mode of delivery,gestational weeks,24-hour amount of postpartum hemorrhage,primary and major pathogenic factors were collected to perform univariate and multivariate logistic regression analysis.Results The top three leading causes were postpartum hemorrhage(39.0%),hypertension(19.1%)and heart disease(8.8%).There was no statistically significant difference between the two groups in age,education,place of residence,pluriparity,prenatal visit,scarred uterus,gestational weeks,and 24-hour amount of postpartum hemorrhage.There were statistically significant differences between the two groups in referral(P=0.028),pre-pregnancy BMI(P<0.001),delivery method(P<0.015),and main pathogenic factors(P<0.001).Logistic regression analysis showed that the pre pregnancy BMI(≥25 kg/m^(2))(P=0.036)and the main pathogenic factors(pregnancy comorbidities)(P=0.003)were the influencing factors for the admission of maternal near miss into ICU.Conclusion The primary pathogenic factors for maternal near miss are still postpartum hemorrhage,hypertension and heart diseases.BMI≥25 kg/m^(2) before pregnancy and pregnancy complications are the risk factors for maternal near miss to be admitted to ICU.