摘要：目的 分析2022—2024年深圳市福田区危重症孕产妇不同亚组（不同并发症/合并症）的流行病学特征、病因构成及相关因素，为优化区域孕产妇健康管理提供依据。方法 基于福田区危重症孕产妇监测网络，对2022年1月1日至2024年12月31日期间107921例孕产妇个案资料进行回顾性描述性分析，采用描述性流行病学方法及卡方检验分析不同因素与危重症主要并发症的关联。结果 深圳市福田区3年间危重症孕产妇共729例，总体发生率为6.75‰。各年度发生率分别为2022年6.67‰、2023年7.38‰和2024年6.33‰。危重症孕产妇中，≥35岁者占33.7%，本科及以上学历者占53.8%。初检妊娠风险评级为黄色者占比最高（41.98%），高危者占21.9%。最常见并发症为产后出血（43.89%），其次为宫缩乏力（17.28%）、前置胎盘（16.59%）、子痫/子痫前期（14.67%）和胎盘植入（13.99%）。血液系统疾病为最常见合并症（57.75%），内分泌系统疾病次之（24.42%）。单因素分析显示，产后出血的发生与高龄、产检次数不足5次、经产妇身份存在统计学关联（均P<0.05）；前置胎盘的发生与高龄、低学历、非汉族、初检高危评级、产检不足5次、经产存在统计学关联（均P<0.05）。结论 深圳市福田区危重症孕产妇发生率约为6.75‰，产后出血和前置胎盘为主要并发症。单因素分析显示，高龄、产检不足、初检高危分级及经产与上述主要并发症的发生相关。应加强动态妊娠风险管理和多学科协作，完善产科早期预警体系，以降低危重症孕产妇发生率，提高母婴安全水平。
Abstract: Objective To analyze the epidemiological characteristics, etiology composition, and related factors of critically ill pregnant women in Futian District, Shenzhen, from 2022 to 2024. Methods Based on the surveillance network, a retrospective descriptive analysis was conducted on 107,921 pregnant women. Chi-square tests were used to analyze the association between different factors and major complications. Results A total of 729 critically ill pregnant women were identified (overall incidence 6.75‰).??The most common complication was postpartum hemorrhage (43.89%), followed by uterine atony (17.28%), placenta previa (16.59%), eclampsia/preeclampsia (14.67%), and placenta accreta (13.99%). Univariate analysis showed that postpartum hemorrhage was statistically associated with advanced age, <5 antenatal visits, and multiparity (all P<0.05). Placenta previa was statistically associated with advanced age, low education level, non-Han ethnicity, high-risk initial assessment, <5 antenatal visits, and multiparity (all P<0.05). Conclusion The incidence of critically ill pregnant women in Futian District is approximately 6.75‰. Univariate analysis suggested that advanced age, insufficient antenatal visits, high-risk classification, and multiparity were associated with the main complications. Dynamic risk management and multidisciplinary collaboration should be strengthened.
目的 探讨产时超声管理妊娠期糖尿病产妇产程的应用价值。方法 选择2022年1月1日—2023年12月31日在佛山市高明区人民医院妇产科分娩的妊娠期糖尿病初产妇共100例。患者签署知情同意书后, 按照1∶1比例采用随机数字表法分为对照组和研究组各50例。对照组采用阴道指诊检查判断产程和分娩方式。研究组采用经腹联合会阴超声测量检查判断产程及分娩方式。收集两组初产妇血糖、血常规、分娩方式、产后24 h出血量以及切口情况, 新生儿Apgar评分。结果 研究组阴道分娩率高于对照组（88.0% vs 72.0%, P<0.05）, 而阴道检查次数（4.18±0.8 vs 6.82±0.8, P<0.05）少于对照组、不良事件发生率（4% vs 16%, P<0.05）低于对照组。相对于对照组,研究组血红蛋白水平较高（104.10±5.25 vs 100.30±4.78, P<0.05）、而白细胞计数（11.40±1.49 vs 12.04±1.66, P<0.05）以及中性粒细胞百分比较低（72.79±4.04 vs 75.01±5.53, P<0.05）。结论 通过产时超声监测判断妊娠期糖尿病初产妇产程,能够降低阴道操作引起的感染等风险,提高阴道分娩率,有效降低产妇感染,提高产妇分娩满意度以及舒适度,改善母婴结局。
Objective To explore the application value of intrapartum ultrasound for labor management of pregnant women with gestational diabetes mellitus．Methods A total of 100 primiparous women with gestational diabetes mellitus who gave birth in the Obstetrics and Gynecology Department of Foshan Gaoming District People’s Hospital from January 1, 2022 to December 31, 2023 were selected．After signing the informed consent form, the patients were randomly divided into a control group and a study group with 50 cases in each group according to a ratio of 1∶1, using a random number table method．The control group underwent vaginal digital examination to assess the labor process and delivery method．For the study group, the labor process and delivery mode were determined using transabdominal ultrasound measurement．Blood glucose level,routine blood test results, delivery methods, 24-hour postpartum bleeding volume and incision conditions of two groups of primiparas, as well as the Apgar score of newborns were collected．Results The study group demonstrated a significantly higher vaginal delivery rate than the control group（88.0% vs 72.0%, P<0.05）, with fewer vaginal examinations（4.18±0.80 vs 6.82±0.80, P<0.05）and a lower incidence of adverse events（4% vs 16%, P<0.05）．Compared to the control group, the study group exhibited higher hemoglobin levels（[104.10±5.25]g/L vs [100.30±4.78] g/L, P<0.05）, but lower white blood cell counts（[11.40±1.49]×109/L vs [12.04±1.66]×109/L, P<0.05）and reduced neutrophil percentages（[72.79±4.04]% vs [75.01±5.53]%, P<0.05）．Conclusions Intrapartum ultrasound monitoring for assessing labor progression in primiparas with gestational diabetes mellitus reduces infection risks associated with vaginal procedures, increases vaginal delivery rates, effectively decreases maternal infections, enhances maternal satisfaction and comfort during delivery,and improves maternal-neonatal outcomes．
目的 了解危重产妇代理决策者的决策困境现状及其影响因素。方法 选择2022年10月—2023年10月许昌市中心医院产科及ICU的262例危重产妇及其代理决策者作为研究对象。应用一般资料问卷、母婴健康素养问卷、决策困境量表、决策参与期待量表进行调查。结果 决策困境量表总分为（39.38±14.58）分,其中信息提供和价值观明确总分为（13.91±7.16）分、社会支持和决策有效性总分为（20.41±8.25）分、不确定性总分为（5.06±1.96）分。多元线性回归分析发现,性别、学历、决策时间和脑卒中防治知识总分对危重产妇代理决策者决策困境均有影响（P<0.05）。结论 危重产妇代理决策者存在决策困境,医护人员需要根据代理决策者的人口学特征、疾病防治知识以及患者疾病特征进行决策辅助,减轻其决策困境,提升决策质量。
Objective To understand the current situation and influencing factors of decision-making difficulties among surrogate decision-makers for critically ill puerpera．Methods A total of 262 critically ill puerpera and their surrogate decision-makers from the obstetrics and ICU of Xuchang Central Hospital from October 2022 to October 2023 were selected．A survey was conducted using the General Information Questionnaire,Maternal and Child Health Literacy Questionnaire,Decision Dilemma Scale,and Decision Participation Expectancy Scale．Results The total score of the Decision Dilemma Scale was（39.38±14.58）,with a total score of（13.91±7.16）for information provision and clear values,（20.41±8.25）for social support and decision effectiveness,and（5.06±1.96）for uncertainty．Multiple linear regression analysis found that gender,education level,decision time and total score of stroke prevention and control knowledge all have an impact on the decision-making difficulties of surrogate decision-makers in critically ill puerpera（P<0.05）．Conclusions There is a decision-making dilemma for the surrogate decision-makers of critically ill puerpera．Medical staff need to provide decision-making assistance based on the demographic characteristics,disease prevention and control knowledge,and patient disease characteristics of the surrogate decision-makers,in order to alleviate their decision-making difficulties and improve the quality of decision-making．
目的 对入住重症监护病房（ICU）重症孕产妇患者的病种特征和住院费用进行分析。方法 从医院信息管理系统中搜索2009—2019年广州市某省级重症孕产妇救治中心ICU的重症孕产妇住院病例,对病例资料进行描述性流行病学分析。结果 2009—2019年该救治中心ICU共收治重症孕产妇1 616例,病种排名前五位依次为心血管疾病430例（26.61%）、血液及造血器官疾病310例（19.18%）、妊娠期特定并发疾病287例（17.76%）、消化系统疾病218例（13.49%）、呼吸系统疾病110例（6.81%）。患者经济负担中位数排名前五位依次为肌肉骨骼系统和结缔组织疾病（62 252.60元）、消化系统疾病（61 684.41元）、感染性疾病（42 945.70元）、血液及造血器官疾病（40 403.52元）、神经系统疾病（40 055.93元）。结论 入住ICU内的重症孕产妇以心血管疾病、血液及造血器官疾病为主,经济学分析表明肌肉骨骼系统和结缔组织疾病造成的经济损失较大。
Objective To analyze the disease characteristics and hospitalization expenses of critically ill maternal patients in intensive care unit（ICU）．Methods Hospitalized cases of severe maternal disease in ICU of a provincial critical care center in Guangzhou from 2009 to 2019 were searched from the hospital information management system,and case data was analyzed by descriptive epidemiology．Results From 2009 to 2019,a total of 1616 critically ill maternal patients received intensive care treatment at this center．The predominant diseases observed were cardiovascular disorders（26.61%）,blood and hematopoietic organ diseases（19.18%）,specific pregnancy-related complications（17.76%）,gastrointestinal ailments（13.49%）,and respiratory disorders（6.81%）．Among the top five patient groups,the median economic burden was the highest in musculoskeletal system and connective tissue diseases（62 252.600 yuan）,followed by digestive system diseases（61 684.410 yuan）,infectious diseases（42 945.700 yuan）,blood and hematopoietic organ diseases（40 403.515 yuan）,and nervous system disorders（40 055.930 yuan）．Furthermore,a discernible correlation between hospitalization cost and length of stay was identified．Conclusions Cardiovascular diseases and disorders of blood and hematopoietic organs are the primary causes for maternal admissions to ICU．Economic analysis shows that musculoskeletal system and connective tissues diseases cause bigger economic loss ．
目的 探讨产科监护室妊娠期糖尿病产妇泌乳启动延迟及影响因素,以期作为预防泌乳启动延迟的参考依据。方法 选择2021年1月—2023年5月期间医院产科监护室接收的妊娠期糖尿病产妇80例为研究对象,采用单因素和多因素分析产妇的年龄、体质指数、产次、定期复查血糖、妊娠期高血压、分娩方式、开奶时间、新生儿体质量、产后焦虑、产后抑郁、产后疲乏、吸吮次数等对泌乳启动延迟的影响。结果 妊娠期糖尿病产妇泌乳启动延迟33例,发生率41.25%;泌乳启动延迟产妇的年龄≥35岁者占51.52%、未定期复查血糖者占39.39%、合并妊娠期高血压者占54.55%、开奶时间≥6 h者占57.58%、产后焦虑者占30.0%、产后抑郁者占36.36%、产后疲乏者占36.36%、吸吮次数<6次者占60.61%,与非泌乳启动延迟产妇比较差异均有统计学意义（P<0.05）。两组孕前体质指数、产次、分娩方式、新生儿出生体质量比较差异无统计学意义（P>0.05）。年龄≥35岁、未定期复查血糖、合并妊娠期高血压、开奶时间≥6 h、产后焦虑、产后抑郁、产后疲乏、吸吮次数<6次为妊娠期糖尿病产妇泌乳启动延迟的危险因素（P<0.05）。结论 产科监护室妊娠期糖尿病产妇泌乳启动延迟发生率较高,主要受到年龄、未定期复查血糖、合并妊娠期高血压、开奶时间、产后心理状态、吸吮次数等因素影响,应重视健康教育和早期辅助干预,降低泌乳启动延迟发生率。
Objective To explore the delayed lactation initiation and its influencing factors of pregnant women with diabetes in the obstetric care unit,so as to provide a reference for preventing delayed lactation initiation．Methods A total of 80 pregnant women with diabetes who were received by the hospital obstetric care unit from January 2021 to May 2023 were selected as the research objects．The age,body mass index,parity,regular blood glucose recheck,pregnancy hypertension,delivery mode,starting time,neonatal weight,postpartum anxiety,postpartum depression,postpartum fatigue,sucking times and other factors that led to the delay of lactation initiation were analyzed by single factor and multi factor analysis．Results The onset of lactation was delayed in 33 pregnant women with diabetes,with an incidence of 41.25%．The age of postpartum women with delayed lactation initiation over 35 years old accounted for 51.52%,blood sugar was not regularly rechecked accounted for 39.39%,pregnancy induced hypertension accounted for 54.55%,lactation time over 6 hours accounted for 57.58%,postpartum anxiety accounted for 30.0%,postpartum depression accounted for 36.36%,postpartum fatigue accounted for 36.36%,and sucking frequency <6 times accounted for 60.61%,which were higher than that of non-delayed lactation initiation women（P<0.05）．There was no statistically significant difference between the two groups in terms of pre pre-pregnancy body mass index,parity,delivery method and newborn birth weight（P>0.05）．The risk factors of delayed lactation initiation in pregnant women with diabetes were age ≥ 35 years,no regular blood glucose review,hypertension during pregnancy,≥ 6 h of first milk expression time,postpartum anxiety,postpartum depression,postpartum fatigue and sucking times<6（P<0.05）．Conclusions The incidence of delayed lactation initiation in pregnant women with diabetes in the obstetric care unit is high,which is mainly affected by age,pregnancy induced hypertension,time of starting breast feeding,postpartum psychological state and sucking times．Health education and early auxiliary intervention should be emphasized to reduce the incidence of delayed lactation initiation．
目的 对比分析在产程不同阶段对妊娠期高血压产妇给予分娩镇痛的效果差异。方法 选择2021年1月—2022年12月在福清市妇幼保健院接受无痛分娩治疗的240例妊娠期高血压产妇,随机分为在产程活跃期实施镇痛的对照组（n=120）和产程潜伏期实施镇痛的实验组（n=120）,比较两组产妇的产程时间、子宫动脉、胎儿脐动脉血流动力学参数、镇痛效果以及母婴结局。结果 实验组的第一、第二、第三产程时间分别为（389.71±35.05）（58.62±5.26）（8.71±0.69）min,略低于对照组的（403.72±42.19）（60.74±7.22）（8.91±1.62）min,但组间比较差异无统计学意义（P>0.05）;实验组镇痛前、活跃期、第二产程的疼痛评分分别为（9.18±0.13）（1.16±0.22）（2.83±1.16）分,与对照组的（9.22±0.16）（1.24±0.32）（2.72±1.09）分比较差异无统计学意义（P>0.05）,但在潜伏期,实验组产妇疼痛评分为（3.32±0.36）分,低于对照组的（8.11±0.32）分（P<0.05）;关闭镇痛泵后,实验组胎儿脐动脉阻力指数、搏动指数、收缩期峰值流速/舒张期流速分别为（0.58±0.09）（0.81±0.14）（2.31±0.29）,与对照组的（0.54±0.11）（0.79±0.13）（2.24±0.27）比较差异无统计学意义（P>0.05）,实验组产妇子宫动脉阻力指数、搏动指数、收缩期峰值流速/舒张期流速分别为（0.42±0.08）（0.64±0.08）（2.31±0.29）,均高于对照组的（0.39±0.06）（0.58±0.11）（1.65±0.08）（P<0.05）;实验组自然分娩、中转剖宫产、阴道助产例数及新生儿Apgar评分分别为87例、23例、10例、（8.88±0.15）分,与对照组的83例、28例、9例、（8.81±0.19）分比较差异无统计学意义（P>0.05）。结论 潜伏期与活跃期对妊娠期高血压产妇实施分娩镇痛对产程时间以及母婴结局的影响不大,但潜伏期镇痛可改善产妇潜伏期的疼痛,可尽早缓解产妇痛苦,且对产妇子宫动脉血流灌注的影响更小。
目的 探讨责任制助产护理模式配合体位管理对高龄产妇分娩方式及产程的影响。方法 选择2023年6月—12月医院接收的高龄产妇68例进行研究，按照护理方式分为两组各34例，对照组为常规助产护理，观察组为责任制助产护理模式配合体位管理，比较两组分娩方式、产程、疼痛程度及护理满意度。结果 观察组阴道分娩率为76.47%（26例），高于对照组52.94%（18例），剖宫产率为8.82%（3例），低于对照组29.41%（10例）（χ2分别为4.121、4.660，均P＜0.05）。观察组第一产程（6.25±0.50）h、第二产程（0.79±0.21）h、总产程（7.15±0.63）h、宫口开大3 cm、10 cm时的疼痛程度（4.12±1.08）分、（6.29±1.25）分明显低于对照组（7.01±0.62）h、（0.96±0.30）h、（8.11±1.07）h、（7.84±1.45）分、（9.09±0.74）分（t分别为5.563、2.706、4.508、11.997、11.239，均P＜0.05）。观察组的护理满意度为97.06%（33例），比对照组的76.47%（26例）高（χ2=4.610，P=0.031）。结论 高龄产妇展开责任制助产护理模式配合体位管理可促进自然分娩，并缩短产程，减轻产时疼痛程度，降低剖宫产率，提高护理满意度。
Objective To explore the effect of responsibility midwifery nursing model combined with position management on delivery mode and labor process of elderly parturient．Methods A total of 68 cases of elderly pregnant women admitted to the hospital from June to December 2023 were selected,and they were divided into two groups according to the nursing mode,34 cases in each group．The control group was given routine midwifery nursing,and the observation group was given responsible midwifery nursing mode combined with position management．The methods of delivery,labor process,pain degree and nursing satisfaction of the two groups were compared．Results The vaginal delivery rate was 76.47%（26 cases）in the observation group,which was higher than 52.94%（18 cases）in the control group,and the cesarean section rate was 8.82%（3 cases）in the observation group,which was lower than 29.41%（10 cases）in the control group（χ2=4.121 and 4.660,P=0.042 and 0.030）．The pain degree of the first stage of labor（6.25±0.50）h,the second stage of labor（0.79±0.21）h,the total stage of labor（7.15±0.63）h,the pain degree of the cervical dilation 3 cm,10 cm in the observation group were significantly lower than those in the control group[（7.01±0.62）h,（4.12±1.08）points,（6.29±1.25）points vs （0.96±0.30）h,（8.11±1.07）h,（7.84±1.45）score,（9.09±0.74）score（t=5.563,2.706,4.508,11.997,11.239,P<0.05）．The nursing satisfaction of the observation group was 97.06%（33 cases）,which was higher than 76.47%（26 cases）of the control group（χ2=4.610,P=0.031）．Conclusion sResponsibility midwifery nursing mode combined with position management can promote natural childbirth,shorten the labor process,reduce the pain during labor,reduce the rate of cesarean section,and improve nursing satisfaction in elderly women,which is worthy of promotion．
目的 分析多元化团体互动健康教育在初产妇女围产期的应用效果。方法 选取2019年6月—2021年6月在我院顺利分娩的168例孕产妇为研究对象,采用随机数字表法分为观察组和对照组,各组均84例,2组围产期均给予常规健康教育,观察组同时给予多元化团体互动健康教育,比较2组的应用效果。结果 观察组孕产妇的各产程和住院时间均短于对照组;观察组产褥期后母亲角色适应情况优于对照组;产后1周和产后1个月较干预前2组的母乳喂养自信量表评分均升高,且观察组较高;干预后较干预前2组的焦虑自评量表和抑郁自评量表评分均降低,且观察组较低;观察组的子宫复旧、恶露量及便秘、尿潴留、切口感染发生率均低于对照组,差异有统计学意义(P＜0.05)。结论 初产妇女围产期给予多元化团体互动健康教育能够帮助其促进产后恢复,较快适应母亲角色,提高母乳喂养能力,缓解负性情绪,降低不良反应。
Objective To analyze the effect of diversified group interactive health education on perinatal period of primiparous women. Methods A total of 168 women who gave birth successfully in our hospital from June 2019 to June 2021 were selected as the research objects, and divided into an observation group and a control group by random number table method, with 84 cases in each group.Both groups were given routine health education during perinatal period, and the observation group was given diversified group interactive health education additionally, the effects of the two groups were compared. Results The duration of labor and hospital stay were shorter in the observation group than in the control group.The maternal role adaptation of observation group was better than control group after puerperium.The Breastfeeding Self-Efficacy Scale scores of 1 week postpartum and 1 month postpartum were higher than those of the two groups before intervention, and the observation group was higher.After intervention, Self-Rating Anxiety Scale and Self-Rating Depression Scale scores of the observation group were lower than those before intervention, and the observation group was lower.Uterine involution, lochia volume, incidence of constipation, urinary retention and incision infection rate in the observation group were lower than those in the control group, and the differences were significant (P<0.05). Conclusions Primiparous women given diversified group interactive health education during the perinatal period can help them to promote postpartum recovery, adapt to being a mother quickly, improve breastfeeding ability, relieve negative emotions, and reduce adverse reactions.
目的 研究不同孕周妊娠期肝内胆汁淤积症（ICP）产妇胆汁酸、肝酶、α-羟丁酸脱氢酶（α-HBDH）水平与围产儿结局关系。方法 采用病例对照研究方法,选取孕中期和晚期ICP组、对照组为研究对象。生化仪检测总胆汁酸（TBA）、血清肝酶、α-HBDH水平。高效液相色谱串联质法检测血清内胆酸（CA）、鹅脱氧胆酸、脱氧胆酸（DCA）、石胆酸（LCA）等游离胆汁酸含量。结果 孕中期ICP组血清内CA、DCA、LCA、TBA丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）均大于孕晚期组,差异有统计学意义（P<0.05）。多因素Logistic 回归分析结果显示：ALT、AST、a-HBDH、CA、DCA、LCA和TBA升高是围产儿不良结局的危险因素。结论 各类胆汁酸、肝酶、α-羟丁酸脱氢酶对围产儿结局预测价值不同。ALT、AST、a-HBDH、CA、DCA、LCA和TBA升高是围产儿不良结局的危险因素。
目的 探讨腰-硬联合阻滞分娩镇痛方式对初产妇在产程进展及产时发热的影响,为临床实践提供理论依据。方法 回顾性分析2020年12月—2021年12月在广州市某三甲医院产科分娩产妇535例的基本资料。观察组（285例）采用腰-硬联合阻滞麻醉分娩镇痛,对照组（250例）选择常规无干预分娩。结果 观察组中的产妇第一产程和第二产程的时间比对照组更长,且产后2 h出血量高于对照组,差异有统计学意义（P<0.05）,除此之外,2组产妇产时发热率比较差异也有统计学意义（P<0.01）。结论 腰硬联合阻滞分娩镇痛在一定程度上会延长产程,且产后2 h的出血量较多,同时也会增加产时发热的概率,存在一定不良反应,故需要密切观察,保证母儿安全。
Objective To investigate the effect of combined spinal-epidural block anesthesia on the progress of labor and intrapartum fever in primipara,and to provide a theoretical basis for clinical practice．Methods The basic data of 535 pregnant women who gave birth in the obstetrics department of a tertiary hospital in Guangzhou from December 2020 to December 2021 were retrospectively analyzed．The observation group（285 cases）was given labor analgesia,and the control group（250 cases）was given routine non-intervention delivery．Results The time of the first stage of labor and the second stage of labor in the observation group was significantly longer than that in the control group,and the bleeding volume 2 hours after delivery was higher than that in the control group,and the difference was statistically significant（P<0.05）．The maternal fever rate during delivery also had statistical significance（P<0.01）．Conclusions Combined spinal-epidural block anesthesia will prolong the labor process to a certain extent,and the amount of bleeding in 2 hours after delivery will be more,and it will also increase the probability of intrapartum fever,with certain adverse reactions．Therefore,close observation is needed to ensure the mother and child safety．
