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中国临床研究:2020,33(9):1235-1238,1242
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妊娠期及产褥期脓毒症的临床特点分析
(深圳市人民医院产科,广东 深圳 518020)
Clinical characteristics of sepsis in pregnancy and puerperium
(Department of Obstetrics and Gynecology, Shenzhen People′s Hospital, Shenzhen,Guangdong 518020, China)
摘要
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投稿时间:2019-12-31   网络发布日期:2020-09-20
中文摘要: 目的 探讨妊娠期和产褥期脓毒症的临床特点及母儿预后。方法 回顾性分析深圳市人民医院产科2003年11月至2018年11月住院确诊的脓毒症患者的临床资料,分析脓毒症发病的临床特点,并评价母儿预后。结果 20例研究对象年龄(30.3±4.36)岁,其中妊娠期和产褥期脓毒症患者各10例,双胎妊娠占比15.0%;经产妇占70.0%;脓毒症的原发感染灶中50.0%为呼吸道感染,生殖道感染、消化系统感染、泌尿系统感染各占15.0%。微生物培养结果最常见的为革兰阴性菌中的大肠埃希菌,占比42.1%。大肠埃希菌常见的敏感抗菌药物为哌拉西林/他唑巴坦、美罗培南,常见的耐药抗菌药物为头孢曲松、头孢噻肟、头孢呋辛酯。脓毒症的经验性治疗中90%使用的是β-内酰胺类抗生素,其中有3例患者予以外科手术干预。20例患者结局,14例治愈,4例死亡,2例失访。围产儿结局,2例流产,1例死胎,余预后良好。结论 妊娠期和产褥期脓毒症是导致孕产妇死亡的重要原因之一,最常见的感染源是呼吸道感染,其次为生殖道感染、消化系统感染、泌尿系统感染。早期识别、及早的经验性抗菌药物治疗、根据药敏结果及时调整抗菌药物、适当的外科手术干预在降低不良母儿结局中起着重要作用。
Abstract:Objective To investigate the clinical characteristics of sepsis in pregnancy and puerperium and the maternal and fetal prognosis. Methods A retrospective analysis was performed in the clinical data of sepsis patients admitted to the obstetrics department of Shenzhen People′s Hospital from November 2003 to November 2018 to study the clinical features of sepsis and evaluate the prognosis of mother and infant. Results Out of 20 subjects with an average age of (30.3±4.36) years, there were 10 cases of sepsis during pregnancy and 10 cases of puerperal sepsis.Twin pregnancy accounted for 15.0%, and multipara accounted for 70%, more than primipara.The primary infection foci were mainly urinary tract infection(50.0%), and reproductive tract infection, digestive system infection and urinary system infection accounted for 15.0% respectively. Escherichia coli was the most common bacteria in the results of biological culture, accounting for 42.1%.The most common sensitive antibiotics for Escherichia coli were piperacillin/tazobactam and meropenem.The most common antibiotics of drug-resistant were ceftriaxone, cefotaxime and cefuroxime axetil.In most patients (90%) treated with β-lactam antibiotics, 3 patients received surgical intervention.Of 20 patients, 14 were cured, 4 were died, and 2 were lost to follow-up.There were 2 cases of abortion and 1 case of stillbirth. Conclusion Sepsis in pregnancy and puerperium is one of the important causes of maternal mortality.The most common source of infection was respiratory tract infection, followed by reproductive tract infection, digestive system infection and urinary system infection.Early identification, empirical antibiotic therapy, timely adjustment of antibiotics based on drug susceptibility test results and appropriate surgical interventions play important roles in reducing adverse maternal and infant outcomes.
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引用文本:
周翠香,折瑞莲,张杰生,林湖滨.妊娠期及产褥期脓毒症的临床特点分析[J].中国临床研究,2020,33(9):1235-1238,1242.

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