入住ICU危重孕产妇的临床特点及妊娠结局分析

发布时间：2018-05-14 03:29

  本文选题：危重孕产妇 + ICU(重症监护病房)　； 参考：《山西医科大学》2017年硕士论文

【摘要】：目的:随着我国二胎政策的全面开放及医学技术的发展,孕产妇的并发症增加,危重孕产妇增加,孕产妇的死亡率亦呈增高趋势。近年来虽然危重孕产妇的文献报道较多,但因为临床工作中妊娠与并发症相互作用,可能掩盖实际病情的严重程度,使得可提供的临床参考数据带有较大的主观性因素,且危重孕产妇的经济水平、文化教育以及各医院医疗水平的不平衡,导致危重孕产妇入住ICU的疾病分布有差异。本文通过探讨近年来入住我院ICU的216例危重孕产妇的一般情况及危重孕产妇及围产儿结局,为保障危重孕产妇及围产儿的生命安全提供可靠的临床诊疗资料。方法:回顾性分析山西医科大学第一医院从2011年4月1日至2016年4月1日近五年间入住ICU的216例危重孕产妇的一般情况(年龄、孕周、总住院天数、危重孕产妇及围产儿死亡情况、疾病病因构成)、转诊与非转诊、规律产检(次数≥5次)与非规律产检(5次)及选择终止妊娠的不同方面对危重孕产妇及围产儿结局的影响。结果:(1)导致入住我院ICU的危重孕产妇最主要病因是妊娠期高血压疾病及其并发症(以子痫前期重度、子痫、HELLP综合征为主)和产后出血(以前置胎盘、胎盘早剥为主),其次是妊娠合并心脏病;(2)转诊与非转诊相比,危重孕产妇及围产儿死亡率差异有统计学意义(P0.05);(3)规律产检(产检次数≥5次)与非规律产检(产检次数5次)相比,危重孕产妇及围产儿的死亡风险有统计学差异(P0.05),且规律产检的孕产妇及围产儿的死亡率相对偏低;(4)不同的原因、时间终止妊娠相比,危重孕产妇及围产儿的死亡风险有统计学差异(P0.05);剖宫产与经阴道分娩相比,围产儿的死亡风险有统计学差异(P0.05),但两者之间危重孕产妇的死亡风险无统计学差异(P0.05)。结论:(1)危重孕产妇入住ICU最主要的病因是产后出血和妊娠期高血压疾病;(2)加强危重孕产妇的产前筛查及孕期管理,可以减少危重孕产妇由高危转为危重,减少危重孕产妇及围产儿的死亡率;(3)在确保危重孕产妇生命安全的前提下,尽可能的使胎儿的孕周延长至34周及以后能明显减少围产儿的死亡率。
[Abstract]:Objective: with the opening of the policy of second child and the development of medical technology, the complications of pregnant and lying-in women increased, and the mortality rate of pregnant women increased. In recent years, although there have been many reports on the literature of critical pregnant women, the interaction between pregnancy and complications in clinical work may cover up the severity of the actual condition, which makes the available clinical reference data have more subjective factors. The imbalance of economic level, culture and education and medical treatment level of critical pregnant women led to the difference in the distribution of diseases of critically ill pregnant women admitted to ICU. This paper discusses the general situation and perinatal outcome of 216 critical pregnant women admitted to ICU in our hospital in recent years, and provides reliable clinical diagnosis and treatment data for ensuring the life safety of critical pregnant women and perinatal infants. Methods: a retrospective analysis of 216 critically ill pregnant women admitted to ICU from April 1, 2011 to April 1, 2016 in the first Hospital of Shanxi Medical University (age, gestational week, total hospitalization days) was performed. The influence of the death of critical pregnant women and perinatal infants, the constitution of disease etiology, referrals and non-referrals, regular perinatal examinations (鈮，

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