上海仁济医院危重孕产妇会诊抢救中心10年危重病例分析
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摘要
目的:探讨危重孕产妇病种分布、病情转归及妊娠结局,总结危重孕产妇的预防措施。方法:回顾性分析设立在上海仁济医院的上海市危重孕产妇会诊抢救中心中2008年1月至2017年12月收住院的危重孕产妇临床资料、抢救记录共903例。结果:①危重孕产妇直接因素283例(31.34%),间接因素620例(68.66%)。顺位前4位的危重病因为:妊娠合并心血管疾病(24.47%)、妊娠合并重度血小板减少(19.05%)、产科出血(16.94%)、重度子痫前期伴严重并发症(13.29%);②ICU入住情况:转入率前3位是妊娠合并心血管疾病(64.25%)、重症肺炎(51.28%)、中枢疾病(47.37%);ICU总体入住率30.56%;③分娩方式:903例孕妇中分娩活胎609例,剖宫产分娩578例(94.91%),阴道分娩31例(5.09%),次(全)子宫切除17例,医源性流(引)产162例(17.94%);④胎儿及新生儿结局:自然流产20例,围产儿死亡31例,新生儿窒息63例,胎儿生长受限26例。结论:本中心危重孕产妇的发生以内外科合并症为主,产科医生需要提高内外科疾病诊治的综合能力,更要强调医院多科合作的联合救治模式,充分发挥ICU的功能。
Objective:To analyze the etiology,development and pregnancy outcome of maternal near miss(MNM),summarize the high-risk factors and preventive measures.Methods:The clinical data and rescue records of MNM treated in Shanghai Renji Hospital from 2008 to 2017 were retrospectively analyzed,including 903 cases in all levels from Shanghai and the surrounding areas transferred to Renji Hospital by three levels of medical institutions.Results:①283 cases(31.34%) with direct factors and 620 cases(68.66%) with indirect factors leading to MNM.The first four critical diseases were cardiovascular disease(24.47%),severe thrombocytopenia(19.05%),obstetric hemorrhage(16.94%),severe preeclampsia with severe complications(13.29%).②The first three critical diseases combined with cardiovascular disease(64.25%),severe pneumonia(51.28%),central disease(47.37%).ICU occupancy rate was 30.56%.③609 cases delivered successfully including 578 cesarean(94.91%) and 31 vaginal delivery(5.09%),unfortunately 17 cases of subtotal hysterectomy,162 cases( 17. 94%) of iatrogenic abortion.(4)20 spontaneous abortion,31 perinatal deaths,63 cases of neonatal asphyxia and 26 cases of fetal growth restriction.Conclusions: Nearly 50% patients in critical condition in Shanghai Renji hospital were from external hospital in Shanghai and neighboring provinces.In this center,the main causes of MNM were internal and surgical complications,which needs obstetrician with improved ability of the diagnosis and treatment of internal and surgical diseases.More emphasis should be placed on the joint treatment mode of multi department cooperation in hospitals,ICU also plays an important role.Reducing the incidence of MNM depends on strengthening the standardized health care of high-risk pregnant women with early detection,assessment,prevention and treatment.
Objective:To analyze the etiology,development and pregnancy outcome of maternal near miss(MNM),summarize the high-risk factors and preventive measures.Methods:The clinical data and rescue records of MNM treated in Shanghai Renji Hospital from 2008 to 2017 were retrospectively analyzed,including 903 cases in all levels from Shanghai and the surrounding areas transferred to Renji Hospital by three levels of medical institutions.Results:①283 cases(31.34%) with direct factors and 620 cases(68.66%) with indirect factors leading to MNM.The first four critical diseases were cardiovascular disease(24.47%),severe thrombocytopenia(19.05%),obstetric hemorrhage(16.94%),severe preeclampsia with severe complications(13.29%).②The first three critical diseases combined with cardiovascular disease(64.25%),severe pneumonia(51.28%),central disease(47.37%).ICU occupancy rate was 30.56%.③609 cases delivered successfully including 578 cesarean(94.91%) and 31 vaginal delivery(5.09%),unfortunately 17 cases of subtotal hysterectomy,162 cases( 17. 94%) of iatrogenic abortion.(4)20 spontaneous abortion,31 perinatal deaths,63 cases of neonatal asphyxia and 26 cases of fetal growth restriction.Conclusions: Nearly 50% patients in critical condition in Shanghai Renji hospital were from external hospital in Shanghai and neighboring provinces.In this center,the main causes of MNM were internal and surgical complications,which needs obstetrician with improved ability of the diagnosis and treatment of internal and surgical diseases.More emphasis should be placed on the joint treatment mode of multi department cooperation in hospitals,ICU also plays an important role.Reducing the incidence of MNM depends on strengthening the standardized health care of high-risk pregnant women with early detection,assessment,prevention and treatment.
引文
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[4] 余琳,胡可佳,杨慧霞,等.2008-2014年凶险性前置胎盘的回顾性临床研究[J].中华妇产科杂志,2016,51(3):169-173.
[5] Sande AK,Torkildsen EA,Sande RK,et al.Maternal allergy as an isolated risk factor for early-onset preeclampsia:An epidemiological study[J].Journal of Reproductive Immunology,2018,6(127):43-47.
[6] Wright D,Rolnik DL,Syngelaki A,et al.Aspirin for evidence-based preeclampsia prevention trial:effect of aspirin on length of stay in the neonatal intensive care unit[J].American Journal of Obstetrics and Gynecology,2018,218(6):612.
[7] Tolcher MC,Chu DM,Hollier LM,et al.Impact of USPSTF recommendations for aspirin for prevention of recurrent preeclampsia[J].American Journal of Obstetrics and Gynecology,2017,217(3):365.
[8] 马袁英,戴红燕,邱丽倩,等.浙江省危重孕产妇监测及其结局分析[J].中华医学杂志,2014,94(41):3252-3255.
[2] Say L,Souza JP,Pattinson RC.WHO working group onmaternal mortality and morbidity classifications.Maternal nearmiss-towards a standard tool for monitoring quality of maternalhealth care[J].Best Pract Res Clin Obstet Gynaecol,2009,23(3):287-296.
[3] Orisaka M,Shukunami K,Orisaka S,et al.Combination therapy for a pregnant woman with severe refractory ITP[J].European Journal of Obstetrics & Gynecology and Reproductive Biology,2005,121(1):119-120.
[4] 余琳,胡可佳,杨慧霞,等.2008-2014年凶险性前置胎盘的回顾性临床研究[J].中华妇产科杂志,2016,51(3):169-173.
[5] Sande AK,Torkildsen EA,Sande RK,et al.Maternal allergy as an isolated risk factor for early-onset preeclampsia:An epidemiological study[J].Journal of Reproductive Immunology,2018,6(127):43-47.
[6] Wright D,Rolnik DL,Syngelaki A,et al.Aspirin for evidence-based preeclampsia prevention trial:effect of aspirin on length of stay in the neonatal intensive care unit[J].American Journal of Obstetrics and Gynecology,2018,218(6):612.
[7] Tolcher MC,Chu DM,Hollier LM,et al.Impact of USPSTF recommendations for aspirin for prevention of recurrent preeclampsia[J].American Journal of Obstetrics and Gynecology,2017,217(3):365.
[8] 马袁英,戴红燕,邱丽倩,等.浙江省危重孕产妇监测及其结局分析[J].中华医学杂志,2014,94(41):3252-3255.