妊娠和产褥期脓毒症14例临床分析

Clinical analysis of 14 cases of sepsis during pregnancy and puerperium

目的:探讨妊娠和产褥期脓毒症的临床特点、感染源、微生物特征、治疗情况与母儿结局。方法:回顾性分析2019至2021年重症医学科收治的14例妊娠和产褥期脓毒症患者的临床资料。结果:9例患者合并基础疾病。主要感染源为生殖道。最常见致病菌为大肠埃希菌。12例孕产妇治愈出院,2例孕产妇死亡。死亡孕妇均存在脓毒性休克。死亡组孕妇入ICU时序贯器官衰竭估计(SOFA)评分的平均值(10.5分)高于存活组SOFA评分的中位数(3.3分)。死亡组孕妇入ICU时的体温均为36.0℃,低于存活组体温的中位数(37.7℃)。结论:妊娠和产褥期脓毒症患者常合并基础疾病,SOFA评分在预后评估中具有重要价值。发热患者一直倍受重视,对于体温正常患者更加不容忽视。

Objective:To explore the clinical characteristics,source of infection,microbial characteristics,treatment,and pregnancy outcomes of sepsis during pregnancy and puerperium.Methods:The clinical data of 14 patients with sepsis during pregnancy and puerperium treated in the Department of Critical Care Medicine in Renmin Hospital of Wuhan University from 2019 to 2021 were analyzed retrospectively.Results:Of the 14 cases,9 cases were complicated with basic diseases.The main source of infection was from reproductive tract.Escherichia coli was the most common pathogenic bacterium.Twelve cases were cured and discharged,and two cases died.All the dead pregnant women had septic shock.The mean sequential organ failure assessment(SOFA)score of pregnant women admitted to the intensive care unit in the death group(10.5 points)was higher than the median of the survival group(3.3 points).The body temperature of pregnant women admitted to the intensive care unit in the death group was 36℃,which was lower than the median in the survival group(37.7℃).Conclusion:Patients with sepsis during pregnancy and puerperium are often complicated with basic diseases.SOFA score has important value in the prognosis evaluation of them.Patients with fever have been paid much attention,and those with normal temperature should not be ignored.