urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.23.5.18BZIWRWurmj-1600Research ArticleОригинальные статьи | Original articlesOriginal articlesИнтегральная оценка степени тяжести родильниц с септическими осложнениями после критических акушерских состоянийAn Integral Assessment of Patient’s Condition in Postpartum Women with Critic Obstetric Complicationshttps://orcid.org/0000-0002-0895-4066ЛазареваО. В.LazarevaO. V.

Оксана Вячеславовна Лазарева — кандидат медицинских наук, доцент кафедры акушерства и гинекологии № 2

Омск

Oksana V. Lazareva - Candidate of Sciences (Medicine), Associate Professor of the Department of Obstetrics and Gynecology No. 2

Omsk

lazow@mail.ruhttps://orcid.org/0000-0002-6113-8498ШифманЕ. М.ShifmanE. M.

Ефим Муневич Шифман — доктор медицинских наук, профессор, профессор кафедры анестезиологии и реаниматологии; профессор кафедры анестезиологии и реаниматологии

Москва

Efim M. Shifman - Doctor of Sciences (Medicine), Professor, Professor of the Department of Anesthesiology and Intensive Care, Moscow Regional Research and Clinical Institute; Professor of the Department of Anesthesiology and Intensive Care

Moscow

eshifman@mail.ruhttps://orcid.org/0000-0002-0357-7097БариновС. В.BarinovS. V.

Сергей Владимирович Баринов — доктор медицинских наук, профессор, заведующий кафедрой акушерства и гинекологии № 2

Омск

Sergey V. Barinov - Doctor of Sciences (Medicine), Professor, Head of the Department of Obstetrics and Gynecology No. 2

Omsk

barinov_omsk@mail.ruhttps://orcid.org/0000-0001-6080-1828ШкабарняЛ. Л.SckabarnyaL. L.

Людмила Леонидовна Шкабарня — заведующий отделением гинекологии

Москва

Омск

Lyudmila L. Sckabarnya - Head of the Department of Gynecology, Regional Clinical Hospital

Omsk

l_shka@mail.ruhttps://orcid.org/0009-0004-2602-2336ТолкачА. Б.TolkachA. B.

Алла Борисовна Толкач — доктор медицинских наук, заведующий отделением реанимации и интенсивной терапии

Омск

lla B. Tolkach — Doctor of Sciences (Medicine), Head of the Department of Anesthesiology and Intensive Care

Omsk

tolkach_omsk@rambler.ruhttps://orcid.org/0009-0000-8107-8819НосковаН. М.NoskovaN. M.

Наталья Митрофановна Носкова — руководитель лаборатории экспресс-диагностики лабораторного отделения

Омск

Natalia M. Noskova - Head of the Laboratory of Express Diagnostics of the Laboratory Department

Moscow

noskova0805@list.ruhttps://orcid.org/0009-0006-3609-184XМартыноваЮ. В.MartynovaYu. V.

Юлия Викторовна Мартынова — врач лаборатории экспресс-диагностики лабораторного отделения

Омск

Yulia V. Martynova - Physician of the Laboratory of Express Diagnostics of the Laboratory Department

Omsk

yulia_1179@mail.ruhttps://orcid.org/0000-0001-5365-7119ТирскаяЮ. И.TirskayaYu. I.

Юлия Игоревна Тирская — доктор медицинских наук, профессор кафедры акушерства и гинекологии № 2

Омск

Yulia I. Tirskaya - Doctor of Sciences (Medicine), Professor of the Department of Obstetrics and Gynecology No. 2

Omsk

yulia.tirskaya@yandex.ruhttps://orcid.org/0000-0002-0348-5985КадцынаТ. В.KadtsynaT. V.

Татьяна Владимировна Кадцына — кандидат медицинских наук, доцент кафедры акушерства и гинекологии № 2

Омск

Tatyana V. Kadtsyna - Candidate of Sciences (Medicine), Associate Professor of the Department of Obstetrics and Gynecology No. 2

Omsk

tatianavlad@list.ruhttps://orcid.org/0000-0002-4806-6880ЧуловскийЮ. И.ChulovskijJ. I.

Юрий Игоревич Чуловский — кандидат медицинских наук, доцент кафедры акушерства и гинекологии № 2

Омск

Jurij I. Chulovskij - Candidate of Sciences (Medicine), Associate Professor of the Department of Obstetricsand Gynecology No. 2

Omsk

akusheromsk@rambler.ruОмский государственный медицинский университетРоссияOmsk Medical UniversityRussian FederationМосковский областной научно‑исследовательский клинический институт имени М. Ф. Владимирского; Российский национальный исследовательский медицинский университет имени Н. И. ПироговаРоссияMoscow Regional Research and Clinical Institute; N. I. Pirogov Russian National Research Medical UniversityRussian FederationОбластная клиническая больницаРоссияRegional Clinical HospitalRussian FederationОбластная клиническая больницаРоссияN. I. Pirogov Russian National Research Medical UniversityRussian Federation20241610202423518–31Copyright © Лазарева О.В., Шифман Е.М., Баринов С.В., Шкабарня Л.Л., Толкач А.Б., Носкова Н.М., Мартынова Ю.В., Тирская Ю.И., Кадцына Т.В., Чуловский Ю.И., 20242024Лазарева О.В., Шифман Е.М., Баринов С.В., Шкабарня Л.Л., Толкач А.Б., Носкова Н.М., Мартынова Ю.В., Тирская Ю.И., Кадцына Т.В., Чуловский Ю.И.Lazareva O.V., Shifman E.M., Barinov S.V., Sckabarnya L.L., Tolkach A.B., Noskova N.M., Martynova Y.V., Tirskaya Y.I., Kadtsyna T.V., Chulovskij J.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1600

Введение. Септические осложнения после критических акушерских состояний (КАС) являются актуальной проблемой акушерства.Цель работы - провести интегральную оценку степени тяжести родильниц с септическими осложнениями после КАС.Материалы и методы. Обследовано 39 родильниц после КАС (массивного акушерского кровотечения, тяжелой преэклампсии). Пациентки разделены на 2 группы: с присоединившимися септическими осложнениями (основная, n = 18) и без них (сравнения, n = 21).Результаты. Массивное акушерское кровотечение осложнилось геморрагическим шоком более чем у 75 % пациенток обеих групп. Преждевременная отслойка нормально расположенной плаценты статистически значимо чаще регистрировалась в основной группе (р = 0,04). Всем пациенткам выполнена тотальная гистерэктомия во время родов или в раннем послеродовом периоде. Синдром полиорганной недостаточности (ПОН) имел место у всех женщин основной группы и у 17/21 (80,95 %) в группе сравнения (р = 0,05). При оценке состояния родильниц с использованием интегральных шкал при поступлении в основной группе отмечалось большее количество баллов по шкалам APACHE II (р = 0,02), SOFA (р = 0,001), NEWS2 (р < 0,001).В этой же группе септические осложнения развивались на 9 [4; 9] сутки после родоразрешения.Заключение. Факторами риска развития септических осложнений после КАС являются: ПОН, почечная недостаточность, острое повреждение почек, сердечная недостаточностью, респираторный дистресс-синдром, пневмония. У родильниц с риском септических осложнений после КАС изначально отмечается увеличение количество баллов по APACHE II, SOFA, NEWS2.

Introduction. Septic complications after critical obstetric conditions (COC) are a pressing problem in obstetrics. The aim of the study is to conduct an integral assessment of the severity of postpartum women with septic complications after COC.Materials and methods. We examined 39 postpartum women after COC (massive obstetric hemorrhage, severe preeclampsia). All patients were divided into 2 groups: the main group (n = 18) — with associated septic complications, the comparison group (n = 21) — without septic complications. The average age of the subjects was (29.80±6.48) years.Results. Obstetric bleeding was complicated by hemorrhagic shock in more than 75 % of patients in both groups. Premature detachment of a normally located placenta (PDNLP) was statistically significantly more often recorded in the main group (p = 0.04). All patients underwent total hysterectomy during childbirth or in the early postpartum period. Multiple organ failure syndrome (MODS) occurred in all women of the main group and in 17/21 (80.95 %) in the comparison group (p = 0.05). When assessing the condition of maternity hospitals using integral scales, a higher number of points were noted in the main group on the APACHE II scale (p = 0.02), SOFA (p = 0.001), NEWS2 (p < 0.001). In the main group, septic complications developed on the 9 [4; 9] day after delivery.Conclusion. Risk factors for septic complications after COC are: MODS, renal failure, acute kidney injury, heart failure, respiratory distress syndrome, pneumonia. Maternity hospitals at risk of septic complications after COC initially show an increase in the number of points according to APACHE II, SOFA, NEWS2.

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The authors declare that there are no conflicts of interest present.