【作者】 侯宇；

【导师】 张新宇；

【作者基本信息】 大连医科大学 ， 妇产科学， 2011， 硕士

【摘要】 目的:据世界卫生组织(WHO)报道:“每一个孕产妇死亡或危及生命的并发症的背后,都有一个故事,了解这些故事所汲取的教训有助于避免这样结果的发生”[1]。本研究分析危重孕产妇入住重症监护室(intensive care unit,ICU)的原因;总结产科联合ICU救治危重孕产妇的经验与预后;为降低孕产妇及围生儿的发病率和死亡率提供临床资料和措施。方法:回顾性分析大连医科大学附属第一医院2006年1月～2010年12月产科联合ICU救治28例危重孕产妇临床资料,评估每个孕产妇的一般情况、妊娠合并症、并发症、分娩方式、入住ICU的时间、母婴预后等,总结出危重孕产妇入住ICU的原因及结局。结果:1.危重孕产妇ICU转入率为0.40%(28/7046)。2.危重孕产妇入住ICU的主要疾病:妊娠并发症占78.57% (22/28);妊娠合并症占21.43%(6/28)。其中妊娠期高血压疾病50.00%(14/28)和产科出血14.29%(4/28)是孕产妇入住ICU的主要疾病。3.妊娠并发多器官功能衰竭是孕产妇死亡的直接原因。器官或系统功能衰竭的发生率以肺脏最高,心血管其次。4.母婴结局:28例孕产妇抢救成功21例,死亡7例,死亡率25%。28例孕产妇共分娩围生儿29例(包括双胎1例),围生儿存活22例,围生儿死亡7例,死亡率24.14%。结论:1.产科联合ICU救治危重孕产妇是现代产科重症抢救的一个新的理念和重大举措,对于保证母婴安全,降低其死亡率具有重要意义。2.当前产科病人入住ICU的最普遍原因是妊娠期高血压疾病和产科出血。3.妊娠并发多器官功能衰竭是孕产妇死亡的直接原因,尤其是并发3个以上器官功能衰竭的病人预后极差。4.规范的产前检查是保障孕产妇和胎、婴儿安全,降低其发病率及死亡率的根本措施,在广大群众中大力宣教并强化围生期保健至关重要。5.产科自身ICU的建立,是现代化产科的发展趋势。更多还原

【Abstract】 Objective: According to the World Health Organization (WHO),“There is a story behind every maternal death or life-threatening complication. Understanding the lessons to be learnt can help to avoid such outcomes”[1]. The objective of this study was to analyze severe maternal indication for ICU, to summarize experiences and prognosis of obstetrics associated with ICU in saving severe maternal and to provide data and measures to decrease maternal and child morbidity and mortality.Methods: The clinical data for 28 cases of critically ill obstetrics patients who were transferred from the Department of Obstetrics to Intensive Care Unit (ICU) at the First Affiliated Hospital of Dalian Medical College during a 5-year period (2006.1-2010.12) were retrospectively analyzed. ICU admittance for maternal general reasons, pregnancy complications, as well as complications, mode of delivery, time of ICU stay, and maternal—fetal outcome were assessed and summed up in terms of critical reasons and outcome.Results: 1. The overall rate of admission into Intensive Care Units was 0.40% (28/7046). 2. The main maternal diseases for admission to an ICU were pregnancy complications in 64.29% of cases and complications in 21.43% of cases. Hypertensive disorders in pregnancy (50.00%) and obstetric hemorrhage (14.29%) are the most frequent obstetric reasons for admission to an ICU. 3. Pregnancy complicated by multiple organ dysfunction syndrome is the direct cause of maternal mortality, The category with the highest frequency of failure occurrence is the lungs, followed by cardiovascular system. 4. Maternal—fetal outcomes: there were 7 cases of maternal death with a death rate of 25%(7/28). There were 7 cases of perinatal child death with a death rate of 24.14% (7/29).Conclusions: 1. Obstetric treatment combined with ICU co-treatment of severe maternal complications is one of the major measures of modern obstetrics intensive rescue effectiveness. Ensuring safe motherhood and reducing mortality rates is very important. 2. Currently, the most frequent obstetric reason for admission to an ICU are Hypertensive disorders and Obstetric hemorrhage. 3. Pregnancy complicated by multiple organ failure is the direct cause of maternal mortality, especially in pregnancy complicated by more than 3 organ failure in patients with poor prognosis. 4. Standard prenatal care is the fundamental measure than protects the mother and the fetus, increases infant safety, and reduces morbidity and mortality. Perinatal care should be vigorously promoted and strengthened. 5. The establishment of obstetric ICU is a modern obstetric trends.更多还原