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中华重症医学电子杂志 ›› 2021, Vol. 07 ›› Issue (03) : 246 -251. doi: 10.3877/cma.j.issn.2096-1537.2021.03.009

重症医学研究

136例危重孕产妇临床特征及其入住ICU的影响因素
许文欣1, 史天一1, 杨子1, 钱惠勤1, 胡燕1, 刘松桥2, 杨毅2, 陈凯3, 王蓓4, 于红1,()   
  1. 1. 210009 南京,东南大学附属中大医院妇产科;210009 南京,江苏省孕产妇危急重症救治指导中心
    2. 210009 南京,江苏省孕产妇危急重症救治指导中心;210009 南京,东南大学附属中大医院重症医学科
    3. 27013 美国北卡罗来纳州,美国诺万特医疗福赛思医学中心母胎医学中心
    4. 210009 南京,东南大学公共卫生学院流行病与统计学系
  • 收稿日期:2021-02-20 出版日期:2021-08-28
  • 通信作者: 于红
  • 基金资助:
    江苏省妇幼健康科研项目(F201810)

Clinical characteristics of 136 maternal near miss and the influence factors of admission to ICU

Wenxin Xu1, Tianyi Shi1, Zi Yang1, Huiqin Qian1, Yan Hu1, Songqiao Liu2, Yi Yang2, Kai Chen3, Bei Wang4, Hong Yu1,()   

  1. 1. Department of Obstetrics and Gynecology, Southeast University Affiliated Zhongda Hospital, Nanjing 210009, China; Guidance Center of Jiangsu Maternal Critical Care, Nanjing 210009, China
    2. Guidance Center of Jiangsu Maternal Critical Care, Nanjing 210009, China; Department of Intensive Care Unit, Southeast University Affiliated Zhongda Hospital, Nanjing 210009, China
    3. Section of Maternal and Fetal Medicine, Novant Medical Forsyth Medical Center, North Carolina 27013, America
    4. Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China
  • Received:2021-02-20 Published:2021-08-28
  • Corresponding author: Hong Yu
引用本文:

许文欣, 史天一, 杨子, 钱惠勤, 胡燕, 刘松桥, 杨毅, 陈凯, 王蓓, 于红. 136例危重孕产妇临床特征及其入住ICU的影响因素[J/OL]. 中华重症医学电子杂志, 2021, 07(03): 246-251.

Wenxin Xu, Tianyi Shi, Zi Yang, Huiqin Qian, Yan Hu, Songqiao Liu, Yi Yang, Kai Chen, Bei Wang, Hong Yu. Clinical characteristics of 136 maternal near miss and the influence factors of admission to ICU[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(03): 246-251.

目的

了解危重孕产妇的流行病学特点,探讨其入住ICU的影响因素。

方法

回顾性分析东南大学附属中大医院2016年1月至2019年12月136例危重孕产妇的临床资料,以是否入住ICU分为未入住ICU组(60例)和入住ICU组(76例)。收集包括年龄、学历、居住地、外院转诊、是否经产妇、是否规律产检、孕前体质量指数(BMI)、瘢痕子宫、分娩方式、分娩孕龄、24 h产后出血量、首要致病因素及主要致病因素等临床特征,并对其进行单因素及多因素Logistic回归分析。

结果

危重孕产妇前3位首要致病因素为产后出血(39.0%),妊娠期高血压疾病(19.1%)及妊娠合并心脏病(8.8%)。2组患者年龄、学历、居住地、是否经产妇、是否规律产检、瘢痕子宫、分娩孕龄、24 h产后出血量比较,差异均无统计学意义(P>0.05)。2组患者外院转诊、孕前BMI、分娩方式、主要致病因素比较,差异均有统计学意义(χ2=4.802,P=0.028;P<0.001;χ2=5.913,P=0.015;χ2=15.074,P<0.001)。多因素回归分析显示孕前BMI(≥25 kg/m2)、主要致病因素(妊娠合并症)是危重孕产妇入住ICU的独立危险因素(OR=31.816,95%CI:1.767~1339.337,P=0.036;OR=31.894,95%CI:5.029~720.700,P=0.003)。

结论

危重孕产妇的首要致病因素仍为产后出血、妊娠期高血压疾病及妊娠合并心脏病,孕前BMI≥25 kg/m2及具有妊娠合并症是危重孕产妇进入ICU的危险因素。

Objective

To investigate the epidemiological characteristics of maternal near miss, and to explore the influencing factors of admission to ICU.

Methods

The clinical data of 136 maternal near miss from January 2016 to December 2019 in the Zhongda Hospital affiliated to Southeast University were retrospectively analyzed. These patients were divided into no-ICU group (60 cases) and ICU group (76 cases). Clinical data including age, education, place of residence, referral, pluriparity, prenatal visit, pre-pregnancy BMI, scarred uterus, mode of delivery, gestational weeks, 24-hour amount of postpartum hemorrhage, primary and major pathogenic factors were collected to perform univariate and multivariate logistic regression analysis.

Results

The top three leading causes were postpartum hemorrhage (39.0%), hypertension (19.1%) and heart disease (8.8%). There was no statistically significant difference between the two groups in age, education, place of residence, pluriparity, prenatal visit, scarred uterus, gestational weeks, and 24-hour amount of postpartum hemorrhage. There were statistically significant differences between the two groups in referral (P=0.028), pre-pregnancy BMI (P<0.001), delivery method (P<0.015), and main pathogenic factors (P<0.001). Logistic regression analysis showed that the pre-pregnancy BMI (≥25 kg/m2) (P=0.036) and the main pathogenic factors (pregnancy comorbidities) (P=0.003) were the influencing factors for the admission of maternal near miss into ICU.

Conclusion

The primary pathogenic factors for maternal near miss are still postpartum hemorrhage, hypertension and heart diseases. BMI≥25 kg/m2 before pregnancy and pregnancy complications are the risk factors for maternal near miss to be admitted to ICU.

表1 136例危重孕产妇首要致病因素[例(%)]
表2 136例危重孕产妇入住ICU的单因素分析[例(%)]
特征因素 总体(136例) 未入住ICU组(60例) 入住ICU组(76例) χ2 P
年龄(岁) 0.061

<35

111 47(42.3) 64(57.7)

35~40

14 10(71.4) 4(28.6)

>40

11 3(27.3) 8(72.7)
学历 0.179 0.672

高中及以上

80 37(46.3) 43(53.7)

高中以下

56 23(41.1) 33(58.9)
居住地 1.773 0.183

城镇

56 29(51.8) 27(48.2)

农村

80 31(38.8) 49(61.2)
外院转诊 4.802 0.028

32 20(62.5) 12(37.5)

104 40(38.5) 64(61.5)
经产妇 1.219 0.270

53 27(50.9) 26(49.1)

83 33(39.8) 50(60.2)
规律产检 0.312 0.577

86 40(46.5) 46(53.5)

50 20(40.0) 30(60.0)
孕前BMI(kg/m2 <0.001

<18.5

5 3(60.0) 2(40.0)

18.5~<25

71 45(63.4) 26(36.6)

≥25

56 9(16.1) 47(83.9)
瘢痕子宫 0.753 0.386

84 40(47.6) 44(52.4)

52 20(38.5) 32(61.5)
分娩方式* 5.913 0.015

阴道分娩

24 17(70.8) 7(29.2)

剖宫产分娩

103 42(40.8) 61(59.2)
分娩孕龄(周)* 0.401 0.818

<28

17 7(41.2) 10(58.8)

28~37

51 23(45.1) 28(54.9)

>37

59 29(49.2) 30(50.8)
产后出血量(ml)* 0.241

<500

39 20(51.3) 19(48.7)

500~1000

28 13(46.4) 15(53.6)

>1000~1500

8 5(62.5) 3(37.5)

>1500~2500

21 12(57.1) 9(42.9)

>2500

31 9(29.0) 22(71.0)
主要致病因素 15.074 <0.001

并发症

100 53(53.0) 47(47.0)

合并症

23 2(8.70) 21(91.3)

两者兼有

13 5(38.5) 8(61.5)
表3 危重孕产妇入住ICU的多因素Logistic回归分析
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