关键词:

危重孕产妇, 急性心肌损伤, 围产期出血

Abstract:

Objective To retrospectively analyze the clinical characteristics and risk factors of critically ill obstetric patients with acute myocardial injury. Methods We conducted a single center，retrospective，cohort study. It enrolled 143 critically ill obstetric patients who received mechanical ventilation，from Jan 1st 2009 to Dec 31th 2019，in Peking University People′s Hospital. Patients′ clinical variables，obstetric variables，outcomes and prognostic variables were collected. According to the diagnostic criteria of myocardial injury ，the patients were assigned to myocardial injury group and non⁃myocardial injury group. Independent risk factors of acute myocardial injury were analyzed by univariate analysis and multivariate logistic regression respectively，and the predicting value of independent risk factors for myocardial injury was estimated by the receiver operating characteristic curve. Results Acute myocardial injury was found in 61 patients（42.7%）. In myocardial injury group，patients′ aspartate aminotransferase（AST），creatinine，albumin，hemoglobulin，lactate，temperature，the incidence of hypotension， time of surgery and the volume of blood loss during operation were increased significantly，when compared with that in non ⁃myocardial injury group（P < 0.05）. After including former variables into multivariate logistic regres⁃ sion，we discovered that early creatinine level（OR = 1.016，95%CI：1.004 ~ 1.027，P = 0.008），lactate level （OR = 1.492，95%CI：1.053 ~ 2.115，P = 0.025）and the volume of blood loss during operation（OR = 1.000 2， 95%CI：1.000 1 ~ 1.000 4，P = 0.011）were independent risk factors of myocardial injury. The area under ROC curve（0.853），standard error（0.033）and 95% confidence intervals（0.789 ~ 0.917）of the receiver operating characteristic curve，indicating a good predicting value. Conclusion Early creatinine level，lactate level and the volume of blood loss during operation are independent risk factors of myocardial injury in critically ill obstetric patients，and play a crucial role in predicting the development of myocardial injury.

Key words:

critically ill obstetric patients, acute myocardial injury, perinatal hemorrhage