基于孕产妇ICU住院时间危险因素分析与预测的回顾性研究

Exploration and prediction of risk factors for the length of stay in the intensive care unit in pregnant and parturient women: A retrospective study

摘要

目的 探讨影响孕产妇入住重症监护室（intensive care unit，ICU）超过48 h的危险因素并寻找预测指标。 方法 纳入重庆医科大学附属妇女儿童医院2023年1月至12月ICU中收治的危重孕妇或产后42 d内产妇，共纳入146例。根据孕产妇在ICU住院时间将其分为≤48 h的短期组（n=60），>48 h的长期组（n=86）。记录并分析孕产妇一般资料、妊娠特征、ICU治疗手段、生命体征及实验室检查等资料。运用受试者工作特征（receiver operating characteristic，ROC）曲线分析上述指标对孕产妇入住ICU超过48 h的预测价值。 结果 与短期组比较，长期组进行机械通气（P=0.001）、放射影像学检查（P=0.022）、降压（P=0.001）、利尿（P=0.001）、抗生素（P=0.006）等药物治疗，以及接受超过5 U输血（P=0.032）等治疗的比例明显升高。长期组孕产妇的孕检次数（P=0.003）明显少于短期组，入住ICU时体质指数（body mass index，BMI）值（P=0.012）明显高于短期组。长期组中合并妊娠期高血压疾病的孕产妇更多（P=0.016）。此外，长期组孕产妇血压水平明显高于短期组（P=0.001），白蛋白、谷丙转氨酶、直接胆红素、24 h尿蛋白与血清肌酐水平与短期组比较，差异有统计学意义（P<0.05）。ROC分析发现无论是收缩压［曲线下面积（area under the curve，AUC）=0.825］、舒张压（AUC=0.782），还是平均动脉压（AUC=0.811）对预测孕产妇ICU住院时间>48 h的评估价值均较高。孕检次数与妊娠期高血压疾病的孕产妇ICU住院时间进一步延长（P<0.05）。 结论 妊娠期高血压疾病是延长孕产妇ICU住院时间的重要危险因素，可为孕产妇的重症监护与管理提供一定思路。

Abstract

Objective To investigate the risk factors for staying in the intensive care unit（ICU） for more than 48 hours in pregnant and parturient women，and to identify related predictive indicators. Methods A total of 146 critically ill pregnant women or parturient women （within 42 days after delivery） who were admitted to the ICU of Women and Children’s Hospital of Chongqing Medical University from January to December 2023 were enrolled in this study. According to the length of stay in the ICU，the pregnant and parturient women were divided into short-term（≤48 hours） group with 60 women and long-term （>48 hours） group with 86 women. Related data were recorded and analyzed，including general information，pregnancy characteristics，ICU interventions，vital signs，and laboratory parameters. The receiver operating characteristic（ROC） curve was used to assess the value of these indicators in predicting the length of stay in the ICU for more than 48 hours in pregnant and parturient women. Results Compared with the short-term group，the long-term group had a significant increase in the proportion of women receiving mechanical ventilation（P=0.001），radiological examination（P=0.022），antihypertensive pharmacotherapy（P=0.001），diuretic pharmacotherapy（P=0.001），antibiotic therapy（P=0.006），and blood transfusion for >5 U（P=0.032）. Compared with the short-term group，the long-term group had a significantly lower number of prenatal visits（P=0.003） and a significantly higher body mass index on admission to the ICU（P=0.012）. The long-term group had a significantly higher number of pregnant and parturient women with hypertensive disorders in pregnancy compared with the short-term group （P=0.016）. In addition，the long-term group had a significantly higher level of blood pressure than the short-term group（P=0.001），and there were significant differences between the two groups in albumin，alanine aminotransferase，direct bilirubin，24-hour urine protein，and serum creatinine（P<0.05）. The ROC analysis showed that systolic blood pressure，diastolic blood pressure，and mean arterial pressure had a relatively high value in predicting the length of stay in the ICU for more than 48 hours in pregnant and parturient women，with an area under the ROC curve of 0.825，0.782，and 0.811，respectively. The length of stay in the ICU was further prolonged for the pregnant and parturient women with a lower number of prenatal visits and hypertensive disorders in pregnancy（P<0.05）. Conclusion Hypertensive disorders in pregnancy are an important risk factor for prolonged stay in the ICU，which can provide certain ideas for the critical care management of pregnant and parturient women.

关键词

孕产妇重症管理 / 妊娠期高血压疾病 / ICU住院时间 / 器官功能障碍

Key words

critical care for pregnant and parturient women / hypertensive disorders in pregnancy / length of stay in the intensive care unit / organ dysfunction