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目的分析危重孕产妇剖宫产术后机械通气的临床特点,探讨机械通气时间延长(≥12 h)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年间共收集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%CI 3.710~72.374,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。
Objective To analyze the clinical features of mechanical ventilation after cesarean section in critically ill pregnant women and to explore the risk factors of prolonged mechanical ventilation (≥12 h). Methods From June 2009 to June 2012, critically ill pregnant women undergoing mechanical ventilation after cesarean section hospitalized in intensive care unit (ICU) of Drum Tower Hospital, Nanjing University Medical College were retrospectively reviewed. Records include patient general information, treatment interventions, causes of mechanical ventilation, and final outcome. Univariate comparisons and multivariate Logistic regression analysis were used to find the risk factors associated with prolonged mechanical ventilation after cesarean section in critically ill pregnant women. Results A total of 61 cases of critically ill pregnant women were collected during the three years. Among them, 21 cases (34.43%) had prolonged mechanical ventilation. Univariate analysis showed that the duration of mechanical ventilation was related to the blood pressure, heart rate, body temperature, albumin level, whether the use of vasoactive drugs, APACHEⅡscore, pulmonary infection or not (P <0.05) . Multivariate Logistic regression analysis showed that body temperature (OR = 16.387, 95% CI 3.710-72.374, P = 0.000), APACHE II score (OR = 1.564, 95% CI 1.023-2.458, P = 0.043) The mean duration of mechanical ventilation after cesarean section in critically ill pregnant women was longer than that of the normal pregnant women (OR = 0.437,95% CI 0.296-0.787, P = 0.034) and gestational age (OR = 0.763,95% CI 0.620-0.939, P = 0.011) Independent risk factors. Conclusions The body temperature, APACHEⅡscore, albumin level and gestational age in ICU were the independent risk factors of prolonging the duration of mechanical ventilation in critically ill pregnant women.