危重孕产妇剖宫产术后机械通气时间延长的危险因素分析

目的分析危重孕产妇剖官产术后机械通气的临床特点，探讨机械通气时间延长（≥12h）的危险因素。方法回顾2009年6月至2012年6月在南京大学医学院附属鼓楼医院重症医学科（ICU）住院的剖宫产术后行机械通气治疗的危重孕产妇。记录包括患者一般情况、治疗干预措施、机械通气的原因和最终结局。采用单因素比较和多因素Logistic回归分析寻找与危重孕产妇剖宫产术后机械通气时间延长有关的危险因素。结果3年问共收集61例危重孕产妇，其中21例（34．43％）患者机械通气时间延长。单因素分析显示机械通气时间延长与孕次、孕周、转入ICU时的血压、心率、体温、白蛋白水平、是否使用血管活性药物、APACHEⅡ评分、是否存在肺部感染有关（P〈0．05）。多因素Logistic回归分析显示转入ICU时的体温（OR=16．387，95％CI3．710—72．374，P=0．000）、APACHEⅡ评分（OR=1．564，95％CI 1．023～2．458，P=0．043）、白蛋白水平（OR=0．437，95％CI 0．296—0．787，P=0．034）和孕周（OR=0．763，95％CI 0．620—0．939，P=0．011）是危重孕产妇剖宫产术后机械通气时间延长的独立危险因素。结论入ICU时的体温、APACHEⅡ评分、白蛋白水平和孕周是导致危重孕产妇机械通气时间延长的独立危险因素。

Risk Factors Analysis of Prolonged Mechanical Ventilation in Critically Ill Obstetric Patients after Cesarean

Objective To analyze risk factors of prolonged mechanical ventilation （ ≥12 hours） in critically ill obstetric patients who underwent mechanical ventilation after cesarean. Methods A retrospective analysis was conducted in critically ill obstetric patients underwent mechanical ventilation after cesarean,who were admitted to the intensive care unit （ICU） between June 2009 and June 2012. The clinical data were recorded including general condition ,treatment interventions, mechanical ventilation causes and outcome. Risk factors for prolonged mechanical ventilation were identified by univariate and multivariate analysis. Results There were 61 critically ill obstetric patients included in the study. Mechanical ventilation was prolonged in 21 cases. Univariate predictors of prolonged mechanical ventilation （ ~〉 12 hours） included gravidity, gestational age, mean blood pressure, heart rate, body temperature, plasma albumin level ,use of vasoactive drugs ,APACHE Ⅱ score and lung infection at admission to ICU. Multivariate modeling identified that the body temperature （ OR = 16. 387,95% CI 3. 710-72. 374, P = 0. 000）, APACHEⅡ score （ OR = 1. 564,95 % CI 1. 023-2.458, P = 0. 043 ）, plasma albumin （ OR = 0. 437,95 % CI O. 296 -0. 787, P = 0. 034） and gestational age （ OR = 0. 763,95 % CI 0. 620-0. 939, P = 0. 011 ） were independent predictors for prolonged mechanical ventilation. Conclusion The body temperature, APACHE I1 score,level of plasma albumin and gestational age are independent predictors for prolonged mechanical ventilation in critically ill obstetric patients.