孕产妇感染性休克61例临床分析

目的:探讨孕产妇感染性休克发生的常见临床因素及其预防措施。方法:回顾性分析2012年1月—2017年12月郑州大学第一附属医院产科收治的61例感染性休克的病例资料。根据结局分为生存组(45例)和死亡组(16例),分析2组患者的临床特征。结果:61例感染性休克的患者死亡16例(26.23%),产褥期患者37例(60.66%)。2组患者急性生理功能和慢性健康状态评分系统Ⅱ(APACHEⅡ)评分比较,差异有统计学意义(t=4.170,P=0.001)。2组患者比较,死亡组患者未足月胎膜早破和多器官功能衰竭(MODS)的发生率增高,差异有统计学意义(均P<0.05)。确诊感染性休克时,死亡组患者较生存组血小板(PLT)下降、凝血酶原时间(PT)增高、纤维蛋白原(FIB)下降、降钙素原(PCT)增高,差异有统计学意义(均P<0.05)。Logistic回归分析提示APACHEⅡ评分高、并存未足月胎膜早破、并发MODS为影响感染性休克孕产妇预后的危险因素。结论:孕产妇发生感染性休克后病死率高;确诊感染性休克后注意监测PLT、PT、FIB、PCT等临床指标变化,加强对其预后的评估;对APACHEⅡ评分高、并存未足月胎膜早破、并发MODS的感染性休克患者,加强临床管理,减少不良预后。

Clinical Analysis of 61 Cases of Septic Shock in Pregnant and Puerperal Women

Objective：To investigate the common clinical factors and preventions of the septic shock in pregnant and puerperal women. Methods: Retrospectively analyzed 61 cases with septic shock hospitalized in the Obstetric Department of The First Affiliated Hospital of Zhengzhou University from January 2012 to December 2017. According to the clinical outcome, the patients were divided into the survival group (45 cases) and the death group (16 cases), then the clinical characteristics between two groups were analyzed. Results: A total of 61 patients, 24 patients were in gestation, 37 patients were in the puerperium, 16 patients (26.23%) died. There was a statistical difference for the score system of acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) between two groups (t=4.170, P=0.001). Compared with survival group, the rate of preterm premature rupture of membranes (PROM) and multiple organ dysfunction syndrome (MODS) significantly increased in the death group (both P＜0.05). The death group also had lower platelet (PLT) and fibrinogen (FIB), but higher prothrombin time (PT) and procalcitonin (PCT). Logistic regression analysis showed that higher APACHE Ⅱ score, coexisting PROM or MODS were risk factors of maternal prognosis. Conclusions: The mortality rate is high in pregnant and puerperal women with septic shock. Once diagnosis of septic shock, in addition to monitoring biochemical indicators such as PLT, PT, FIB and PCT, more clinical management should be performed in patients with higher APACHE Ⅱ score, occurrence of PPOM or MODS to improve maternal poor prognosis.