孕产妇心脏骤停的临床研究

发布时间：2018-11-15 14:31

【摘要】：目的探讨孕产妇心脏骤停预后的影响因素,为抢救危重孕产妇(MNM)心脏骤停提供理论依据。方法通过分层随机整群抽样回顾性分析湖南省18家医院2012年1月1日-2013年12月31日入院的所有孕产妇,依据孕产妇心脏骤停后是否死亡分为孕产妇死亡MD组和MNM组,分析患者的年龄、孕次、产次、孕周、产前检查次数、分娩方式、合并慢性基础疾病、目击者早期识别、是否入住重症加强护理病房(ICU)及早期高级生命支持等,采用SPSS 18.0统计软件进行数据分析。结果该研究共收集129 259例孕产妇,发生心脏骤停21例,孕产妇心脏骤停的发病率为1∶6 155次分娩,发生心脏骤停的孕产妇中死亡16例,孕产妇发生心脏骤停后的病死率为76.19%(16/21)。21例心脏骤停患者行初级心肺复苏,11例成功,10例失败。MD组与MNM组在产前检查≥5次,目击者早期识别,入住ICU和正确及时的高级生命支持方面比较,差异均有统计学意义(P=0.006、0.011、0.025和0.035)。两组孕产妇的年龄、孕次、产次、孕周、文化程度以及剖宫产次数等比较,差异均无统计学意义。孕周20周而胎儿未娩出发生的5例心脏骤停患者中,3例行围死亡期剖宫产术(PMCS)的孕妇均存活,未行PMCS的2例孕妇死亡。结论早期识别并予以就地心肺复苏及正确、及时的高级生命支持是心肺复苏成功的关键。孕周20周的孕妇发生心脏骤停时,建议尽快实施PMCS。分娩量大的医疗保健机构应建立ICU,并加强对心脏骤停高危对象的识别培训,有利于预防和降低孕产妇心脏骤停的发生。
[Abstract]:Objective to explore the prognostic factors of sudden cardiac arrest in pregnant women and to provide theoretical basis for rescuing (MNM) cardiac arrest in critical pregnant women. Methods all the pregnant and lying-in women admitted to 18 hospitals in Hunan province from January 1, 2012 to December 31, 2013 were retrospectively analyzed by stratified random cluster sampling. According to the death of pregnant and lying-in women after cardiac arrest, they were divided into MD group and MNM group. Age, pregnancy, parturition, gestational week, antenatal examination, delivery mode, complicated chronic basic disease, early identification of eyewitness, (ICU) in intensive care unit and early advanced life support were analyzed. The data were analyzed by SPSS 18.0 software. Results the study collected 129 259 pregnant and lying-in women, 21 cases of cardiac arrest, the incidence of sudden cardiac arrest was 1:6 155 births, 16 cases of sudden cardiac arrest maternal deaths, The mortality of pregnant women after cardiac arrest was 76.19% (16 / 21). Primary cardiopulmonary resuscitation was performed in 21 patients with cardiac arrest, 11 cases were successful and 10 cases failed. MD group and MNM group had more than 5 antenatal examinations and early eyewitness identification. There were significant differences between ICU and accurate and timely advanced life support (P0. 006, 0. 0110. 025 and 0.035). There was no significant difference in age, pregnancy, delivery, gestational age, education and cesarean section between the two groups. Of the 5 patients with cardiac arrest who were not delivered at 20 weeks of gestation, 3 pregnant women who underwent peri-death cesarean section (PMCS) survived, and 2 women who did not undergo PMCS died. Conclusion early identification and local cardiopulmonary resuscitation are the key to success of CPR. When cardiac arrest occurs in pregnant women of 20 weeks of gestation, it is recommended that PMCS. be implemented as soon as possible In order to prevent and reduce the occurrence of sudden cardiac arrest in pregnant women, ICU, should be established in medical care institutions with large number of births and training on the identification of high-risk subjects for cardiac arrest should be strengthened.
【作者单位】：湖南省妇幼保健院;
【基金】：湖南省卫生厅科技基金(No:2012-B110)
【分类号】：R714

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