测量产妇重症监护入院对短期和长期母婴及分娩结局的影响。

Measuring the impact of maternal critical care admission on short- and longer-term maternal and birth outcomes.

机构信息

Department of Anaesthesia, Critical Care, and Pain Medicine, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK.

Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, UK.

出版信息

Intensive Care Med. 2024 Jun;50(6):890-900. doi: 10.1007/s00134-024-07417-4. Epub 2024 Jun 7.

DOI:10.1007/s00134-024-07417-4

PMID:38844640

Abstract

PURPOSE

Factors increasing the risk of maternal critical illness are rising in prevalence in maternity populations. Studies of general critical care populations highlight that severe illness is associated with longer-term physical and psychological morbidity. We aimed to compare short- and longer-term outcomes between women who required critical care admission during pregnancy/puerperium and those who did not.

METHODS

This is a cohort study including all women delivering in Scottish hospitals between 01/01/2005 and 31/12/2018, using national healthcare databases. The primary exposure was intensive care unit (ICU) admission, while secondary exposures included high dependency unit admission. Outcomes included hospital readmission (1-year post-hospital discharge, 1-year mortality, psychiatric hospital admission, stillbirth, and neonatal critical care admission). Multivariable Cox and logistic regression were used to report hazard ratios (HR) and odds ratios (OR) of association between ICU admission and outcomes.

RESULTS

Of 762,918 deliveries, 1449 (0.18%) women were admitted to ICU, most commonly due to post-partum hemorrhage (225, 15.5%) followed by eclampsia/pre-eclampsia (133, 9.2%). Over-half (53.8%) required mechanical ventilation. One-year hospital readmission was more frequent in women admitted to ICU compared with non-ICU populations [24.5% (n = 299) vs 8.9% (n = 68,029)]. This association persisted after confounder adjustment (HR 1.93, 95% confidence interval [CI] 1.33, 2.81, p < 0.001). Furthermore, maternal ICU admission was associated with increased 1-year mortality (HR 40.06, 95% CI 24.04, 66.76, p < 0.001), stillbirth (OR 12.31, 95% CI 7.95,19.08, p < 0.001) and neonatal critical care admission (OR 6.99, 95% CI 5.64,8.67, p < 0.001) after confounder adjustment.

CONCLUSION

Critical care admission increases the risk of adverse short-term and long-term maternal, pregnancy and neonatal outcomes. Optimizing long-term post-partum care may benefit maternal critical illness survivors.

摘要

目的

在产妇人群中，导致产妇重症的风险因素日益增多。对普通重症监护人群的研究表明，严重疾病与长期的身体和心理发病率有关。我们旨在比较妊娠/产褥期需要重症监护入院的妇女和不需要重症监护入院的妇女的短期和长期结局。

方法

这是一项队列研究，纳入了 2005 年 1 月 1 日至 2018 年 12 月 31 日期间在苏格兰医院分娩的所有妇女，使用国家医疗保健数据库。主要暴露因素是重症监护病房（ICU）入院，而次要暴露因素包括高度依赖病房入院。结局包括住院后 1 年再次入院（出院后 1 年，1 年死亡率，精神科住院，死产和新生儿重症监护入院）。多变量 Cox 和逻辑回归用于报告 ICU 入院与结局之间的风险比（HR）和优势比（OR）。

结果

在 762,918 次分娩中，有 1449 名（0.18%）妇女被收入 ICU，最常见的原因是产后出血（225 例，15.5%），其次是子痫/子痫前期（133 例，9.2%）。超过一半（53.8%）需要机械通气。与非 ICU 人群相比，ICU 入院的女性 1 年后再次住院的可能性更高[24.5%（n=299）比 8.9%（n=68,029）]。在调整混杂因素后，这种关联仍然存在（HR 1.93，95%置信区间[CI] 1.33，2.81，p<0.001）。此外，产妇 ICU 入院与 1 年死亡率增加相关（HR 40.06，95%CI 24.04，66.76，p<0.001），死产（OR 12.31，95%CI 7.95，19.08，p<0.001）和新生儿重症监护入院（OR 6.99，95%CI 5.64，8.67，p<0.001），在调整混杂因素后。