Vasquez Daniela N, Estenssoro Elisa, Canales Héctor S, Reina Rosa, Saenz María G, Das Neves Andrea V, Toro María A, Loudet Cecilia I
The Intensive Care Unit, Hospital Interzonal General de Agudos Gral, San Martín, La Plata, Buenos Aires, Argentina.
The Intensive Care Unit, Hospital Interzonal General de Agudos Gral, San Martín, La Plata, Buenos Aires, Argentina.
Chest. 2007 Mar;131(3):718-724. doi: 10.1378/chest.06-2388.
To review a series of critically ill obstetric patients admitted to our ICU to assess the spectrum of disease, required interventions, and fetal/maternal mortality, and to identify conditions associated with maternal death.
Retrospective cohort.
Medical-surgical ICU in a university-affiliated hospital.
Pregnant/postpartum admissions between January 1, 1998, and September 30, 2005.
None.
We studied 161 patients (age, 28 +/- 9 years; mean gestational age, 29 +/- 9 weeks) [mean +/- SD], constituting 10% of 1,571 hospital admissions. APACHE (acute physiology and chronic health evaluation) II score was 14 +/- 8, with 24% predicted mortality; sequential organ failure assessment score was 5 +/- 3; and therapeutic intervention scoring system at 24 h was 25 +/- 9. Forty-one percent of patients required mechanical ventilation (MV). ARDS, shock, and organ dysfunction were present in 19%, 25%, and 48% of patients, respectively. Most patients (63%) were admitted postpartum, and 74% of admissions were of obstetric cause. Hypertensive disease (40%), major hemorrhage (16%), septic abortion (12%), and nonobstetric sepsis (10%) were the principal diagnoses. Maternal mortality was 11%, with multiple organ dysfunction syndrome (44%) and intracranial hemorrhage (39%) as main causes. There were no differences in death rate in patients admitted for obstetric and nonobstetric causes. Fetal mortality was 32%. Only 30% of patients received antenatal care, which was more frequent in survivors (33% vs 6% nonsurvivors, p = 0.014).
Although ARDS, organ failures, shock, and use of MV were extremely frequent in this population, maternal mortality remains within an acceptable range. APACHE II overpredicted mortality in these patients. Septic abortion is still an important modifiable cause of mortality. Efforts should concentrate in increasing antenatal care, which was clearly underprovided in these patients.
回顾一系列入住我院重症监护病房（ICU）的重症产科患者，以评估疾病谱、所需干预措施及胎儿/母亲死亡率，并确定与母亲死亡相关的情况。
回顾性队列研究。
大学附属医院的内科-外科ICU。
1998年1月1日至2005年9月30日期间的妊娠/产后入院患者。
无。
我们研究了161例患者（年龄28±9岁；平均孕周29±9周）[均值±标准差]，占1571例住院患者的10%。急性生理与慢性健康状况评估（APACHE）II评分14±8，预计死亡率为24%；序贯器官衰竭评估评分5±3；24小时治疗干预评分系统评分为25±9。41%的患者需要机械通气（MV）。分别有19%、25%和48%的患者出现急性呼吸窘迫综合征（ARDS）、休克和器官功能障碍。大多数患者（63%）在产后入院，74%的入院是由产科原因导致。主要诊断包括高血压疾病（40%）、大出血（16%）、感染性流产（12%）和非产科败血症（10%）。母亲死亡率为11%，主要原因是多器官功能障碍综合征（4部分4%）和颅内出血（39%）。因产科和非产科原因入院的患者死亡率无差异。胎儿死亡率为32%。只有30%的患者接受了产前护理，幸存者中接受产前护理的比例更高（33%对非幸存者的6%，p = 0.014）。
尽管ARDS、器官衰竭、休克和MV的使用在该人群中极为常见，但母亲死亡率仍在可接受范围内。APACHE II对这些患者的死亡率预测过高。感染性流产仍是一个重要的可改变的死亡原因。应集中精力增加产前护理，而这些患者显然产前护理不足。
