Clinical analysis of severe pneumonia during pregnancy
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摘要:
目的 探讨妊娠合并重症肺炎患者的临床及实验室检查特点。 方法 回顾分析2013年3月~2016年10月入住我科的妊娠合并肺炎患者共18例，其中未行气管插管9例，重症肺炎气管插管9例。分析其临床症状、体征、入院生化及感染指标、住院时间、孕妇及胎儿结局等。 结果 两组患者怀孕次数差异无统计学意义，但是分娩次数差异有统计学意义(1.7±1.1次 vs 0.7±0.7次 ，P=0.038)，成功分娩次数高的患者插管率更低；插管患者孕周更少，但两组差异无统计学意义(27.6±6.9周 vs 33.1±5.1周，P=0.078)；肺炎患者血红蛋白和血清白蛋白偏低，但是插管组与未插管组差异无统计学意义(P>0.05)；插管组ICU住院时间为11.6±8.7 d，未插管组2.8±1.6 d，两组差异具有统计学意义(P<0.05)；未插管组无孕妇死亡，插管组死亡2例(2/9)。 结论 妊娠失败次数越多，感染肺炎后插管率越高。孕中期感染肺炎病情可能更重。血红蛋白及白蛋白水平低的肺炎患者可能插管风险更高。妊娠合并肺炎气管插管患者ICU病房住院时间更长，死亡率高。 Abstract:Objective To investigate the clinical and laboratory characteristics of severe pneumonia during pregnancy. Methods Eighteen cases of pneumonia with pregnant in our department from March 2013 to October 2016 were retrospectively analyzed. Nine cases recieved tracheal intubation and the other 9 cases were not.Clinical manifestations, biochemical and infection indicators during admission, hospital days, pregnant women and fetal outcomes were analyzed. Results There were no significant differences of pregnancy times between two groups.But the delivery times of two group were significantly different(1.7±1.1 vs 0.7±0.7, P=0.038); Difference of gestational weeks in two groups was not significant(P>0.05).The concentration of hemoglobin and serum albumin was low in patient with pneumonia, but there was no significant difference between two group(P>0.05); ICU stay in intubated group and non intubated group were significantly different(P<0.05).No pregnant women died in non intubatd group, 2 casesin intubated group died(2/9). Conclusion The more the failure of pregnancy, the higher the rate of intubation after pneumonia.Pneumonia may be more severe in the second trimester.Patients with low hemoglobin and albumin are predisposed to intubation.Patients of pregnancy complicated with pneumonia in intubation have a longer ICU stay and a high mortality. -
Key words:
- pregnancy /
- severe pneumonia /
- tracheal intubation
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表 1 两组患者一般情况对比
项目 插管组 未插管组 平均 年龄(岁) 27.4±5.8 29.3±6.7 28.4±6.2 发病月份 6.6±3.3 5.3±3.2 5.9±3.2 体温(℃) 37.6±1.2 38.2±1.2 37.9±1.2 心率(次/min) 121.4±17.8 120.9±18.8 121.2±17.8 呼吸(次/min) 33.1±11.3 24.6±8.1 28.8±10.5 MAP(mmHg) 77.9±6.7 84.1±17.4 81±13.2 咳嗽(%) 78(7/9) 67(6/9) 72(13/18) 咳痰(%) 44(4/9) 78(7/9) 61(11/18) 发热(%) 78(7/9) 100(9/9) 89(16/18) 气促(%) 33(3/9) 67(6/9) 50(9/18) 总住院时间(d) 13.7±9.2 8.6±3.9 11.1±7.3 ICU住院时间(d) 11.6±8.7 2.8±1.6* 7.2±7.5 MV时间(d) 7.2±7.5 0 - *P<0.05 vs插管组; MV: 机械通气, MAP: 平均动脉压. 
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表 2 两组血常规对比
分组 白细胞(×109/L) 血红蛋白(g/L) 血小板(×109/L) 插管组 10.7±4.9 85.9±14.2 180.4±77.1 未插管组 10.2±7.4 87.7±14.8 177±56.1 t -0.169 -0.26 -0.108 P 0.868 0.798 0.915
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表 3 两组产科数据对比
分组 怀孕次数(次) 分娩次数(次) 孕周(周) 插管组 3.3±2.2 0.7±0.7 27.6±6.9 未插管组 3.3±1.6 1.7±1.1 33.1±5.5 t 0.000 2.268 1.885 P 1 0.038 0.078
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表 4 两组生化指标对比
分组 BNP (pg/mL) 降钙素原(ng/mL) 乳酸(mmol/L) 白蛋白(g/L) 肌酐(μmol/L) 插管组 785.2±725.9 4.1±6.7 2.4±1.1 28.8±3.9 46.3±7.8 未插管组 932.2±1341.7 1.5±2.1 1.9±0.9 27.2±4.7 63.9±61.7 t 0.289 –1.113 –1.112 –0.816 0.847 P 0.776 0.282 0.283 0.427 0.409
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