世界卫生组织的接近错失标准适用于中国重症孕妇入住重症监护病房。

The WHO near miss criteria are appropriate for admission of critically ill pregnant women to intensive care units in China.

机构信息

Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.

出版信息

Chin Med J (Engl). 2013 Mar;126(5):895-8.

Abstract

BACKGROUND

Evaluation of the severity of the pregnant women with suitable admission to the Intensive Care Unit (ICU) is very important for obstetricians. By now there are no criteria for critically ill obstetric patients admitted to the ICU. In this article, we investigated the admission criteria of critically ill patients admitted to the ICU in order to provide a referral basis of reasonable use of the ICU.

METHODS

A retrospective analysis of critically ill pregnant women admitted to the ICU in Perking University Third Hospital in China in the last 6 years (from January 2006 to December 2011) was performed, using acute physiology and chronic health evaluation II (APACHE-II), Marshall and WHO near miss criteria to assess the severity of illness of patients.

RESULTS

There were 101 critically ill pregnant patients admitted to the ICU. Among them, 25.7% women were complicated with internal or surgical diseases, and 23.8% women were patients of postpartum hemorrhage and 23.8% women were patients of pregnancy-induced hypertension. Sixty-nine cases (68.3%) were administrated with adjunct respiration with a respirator. Sixteen cases (15.8%) required 1-2 types of vasoactive drugs. Fifty-five cases (54.5%) required a hemodynamic monitoring. Seventy-three cases (72.3%) had multiple organ dysfunctions (MODS). The average duration in ICU was (7.5 ± 3.0) days. A total of 12.9%, 23.8% and 74.3% of women were diagnosed as critically ill according to the APACHE-II, Marshall and WHO near miss criteria, respectively. The rate was significantly different according to the three criteria (P < 0.01).

CONCLUSIONS

The WHO near miss criteria can correctly reflect the severity of illness of pregnant women, and the WHO near miss criteria are appropriate for admission of critically ill pregnant women to ICU in China.

摘要

背景

评估适合入住重症监护病房（ICU）的孕妇的严重程度对产科医生非常重要。到目前为止，还没有 ICU 收治的危重症产科患者的标准。本文旨在探讨 ICU 收治的危重症患者的收治标准，为合理使用 ICU 提供参考依据。

方法

回顾性分析中国北京大学第三医院近 6 年（2006 年 1 月至 2011 年 12 月）收治的 ICU 危重症孕妇 101 例，采用急性生理学与慢性健康状况评分系统Ⅱ（APACHE-Ⅱ）、Marshall 和 WHO 孕产妇严重并发症预警评分标准评估患者病情严重程度。

结果

共收治 101 例危重症孕妇，其中合并内外科疾病者占 25.7%，产后出血患者占 23.8%，妊娠高血压疾病患者占 23.8%。69 例（68.3%）患者需辅助呼吸，应用呼吸机；16 例（15.8%）患者需应用 1~2 种血管活性药物；55 例（54.5%）患者需进行血流动力学监测；73 例（72.3%）患者发生多器官功能障碍综合征（MODS）。患者 ICU 住院时间为（7.5±3.0）d。分别有 12.9%、23.8%和 74.3%的患者按 APACHE-Ⅱ评分、Marshall 评分和 WHO 孕产妇严重并发症预警评分标准诊断为危重症，三种评分标准的诊断结果差异有统计学意义（P<0.01）。