妊娠期及产后脓毒症病例特点和病原学分析

Characteristics and pathogenic analysis of patients with sepsis during pregnancy and postpartum period

目的:探讨妊娠期及产后脓毒症的临床特征、病原学特点和进展为脓毒性休克过程中的危险因素.方法:选取2012年6月-2022年6月本院住院的妊娠期及产后脓毒症患者58例临床资料,根据脓毒症患者是否伴有休克分为伴休克组和不伴休克组,分析其临床特征、病原学特征、治疗及预后.结果:58例中不伴休克组48例(82.8%)、休克组10例(17.2%).与不伴休克组比,伴休克组诊断脓毒症时间多在产前,产后发生脓毒症者终止妊娠孕周减小,体外受精-胚胎移植妊娠、分娩期并发症、紧急剖宫产、生殖道侵入性操作、呼吸系统障碍、凝血系统障碍、中枢神经系统障碍、心功能障碍、功能障碍器官数、多器官功能障碍综合征、弥散性血管内凝血、平均动脉压(MAP)≤65mmHg、乳酸值、序贯器官衰竭评分、重症加强护理病房入住及入住时间、血管活性药物及输血制品使用等情况均高于不伴休克组(均P<0.05).logistic回归分析,影响产科脓毒症的独立危险因素是紧急剖宫产和MAP≤65mmHg(均P<0.05).结论:影响产科脓毒症的独立危险因素是紧急剖宫产和MAP≤65mmHg,临床需加强脓毒症及疑似脓毒症的孕产妇进行有效监测,及时发现高危因素,早期识别并积极治疗,最大程度改善母儿预后.

Objective:To investigate the clinical features,the pathogenic microbiologiceal characteristcs and the risk factors in the process of progression to septic shock of patients with sepsis during pregnancy and postpartum period.Methods:The clinical data of 58 patients with sepsis during pregnancy and postpartum period from June 2012 to June 2022 were selected and divided into group A(patients with shock)and group B(patients without shock)according to whether the patients with shock or not.The clinical features,the pathogenic characteristics,the treatment and the prognosis of the patients in the two groups were analyzed.Results:There were 48(82.8%)patients in group B and 10(17.2%)patients in group A.The rate of the sepsis diagnosed before delivery of the patients in group A was significantly higher than that of the patients in group B.The gestational weeks of the patients with postpartum sepsis in group A were significantly less than that of the patients in group B.The rats of in witro fertilization and embryo transfer pregnancy,the delivery complications,the emergency cesarean section.the reproductive tract invasive operation.the respiratory system disorders,the coagulation system disorders,the central nervous system disorders and the cardiac dysfunction of the patients in group A were significantly higher than those of the patients in group B.The number of dysfunctional organs,the rates of multiple organ dysfunction syndrome,disseminated intravascular coagulation,mean arterial pressure(MAP)≤65mmHg and sequential organ failure,the lactic acid value,the exhaustion score,the rate of intensive care unit admission and the duration of stay in care unit,and the rates of vasoactive drugs and blood transfusion products used of the patients in group A were significantly higher than those of the patients in group B(all P<0.05).Logistic regression analysis showed that the emergency cesarean section and MAP≤65mmHg of the paticnts were the independent risk factors of their obstetric sepsis occurrence(all P<0.05).Conclusion:The emergency cesarean section and MAP≤65mmHg of the patients are the independent risk factors of their obstetric occurrence.The patients with sepsis or with suspected sepsis should be enhanced the monitoring in clinic for carly finding the high-risk factors.The sepsis of the patients should be identified and treated early,so as to improve the prognosis of the patients at the greatest extent.